Animal Medical Center

460 Hartman Run Rd
Morgantown, WV 26505

(304)292-0126

morgantownamc.com

New Client Registration & Appointment Request

No DescriptionWelcome to Animal Medical Center. We appreciate the opportunity to serve you and your pets.

If you are a new client and would like to make an appointment, you can help us expedite your check in by submitting the electronic form below. Please complete it as best you can. We can complete any missing information or add any additional pets at check in or over the phone.

We appreciate the opportunity to serve you and we look forward to meeting you and your pets.

If your pet has received veterinary care elsewhere in the past, please try to bring a copy of his medical records to your first appointment or ask your prior veterinarian for the records. Most veterinarians are happy to fax or email records -- just give them our phone/fax or email and they will take care of the rest. If you need our assistance in getting records, just let us know and we'll help!

Don't forget to check for your welcome savings on our Special Offers page!

New Client Registration

Name (required)
First Name (required)
Last Name (required)
Secondary Name (Spouse)
First Name
Last Name
Do you have an appointment scheduled already? (required)
(Select One)
Not yet, please call me at any of my numbers to schedule
Not yet, please call me at home to schedule
Not yet, please call me at work to schedule
Not yet, please call me on my cell to schedule
Not yet, I plan to call this week
Yes


Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
E-Mail Address :
Primary Phone (required)
Phone TypePhone Number (required)
Other Phone
Phone TypePhone Number
Other Phone
Phone TypePhone Number
How were you referred to AMC?
How did you first learn of AMC? (required)
(Select One)
Referred by a friend
AMC website or facebook page
Online Review
Saw Sign
Another Veterinarian
Pet Insurance Provider
Word of Mouth
AAHA Hospital Locator
Newspaper Ad
Other
Was a previous client


If you were referred by an AMC client, please give us their name(s) so we can thank them.

If you list "Other", please describe how you found AMC.

Your Pet
Pet's Name (required)

Species (required)
(Select One)
cat
dog
other


If your pet species is "other", what is it (african grey parrot, gerbil, etc.)?

Breed? (required)

Sex? (required)
(Select One)
unknown
neutered male
intact male
spayed female
intact female


Color? (required)

Birth Date or Age? (required)

Veterinary History (required)
(Select One)
This will be my pet's first visit to a veterinarian.
My pet has had prior veterinary care and I will be able to bring copies of his medical records with me to our appointment.
My pet has had prior veterinary care but I don't have his records yet. Please contact me to help me get the records faxed or mailed to AMC.
My pet may have had prior veterinary care but I don't have records and I don't know what veterinarian(s) provided the care.


Additional Information About My Pet (medical conditions, etc.)

Your Appointment
Please tell us the reason for your pets visit: (required)

What appointment time(s) or day(s) work best for you?

Additional Comments or Requests


Check the reCAPTCHA to ensure you are not a robot:


Animal Medical Center
460 Hartman Run Road
Morgantown, WV 26505
(304) 292-0126




 




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