Allegheny Equine Veterinary Service

New Client-Patient Registration Form

Owners: Please fill out our online form or print, fill-in, sign, date, and return the following New Client-Patient Registration form for your equine or livestock patient to:

Allegheny Equine Veterinary Service
P.O. Box 2116
Elkins, WV 26241

New Client / New Patient Registration PDF

Online New Client / New Patient Registration Form

  • Owner/Client Information:

  • Name * Required
  • Address * Required
  • Pet/ Patient Information:

  • Sex * Required
  • Are copies of previous medical records available? * Required
  • Does the patient have any known pre-existing medical problems? * Required
  • Farm Location / Boarding Stable / Trainer Information:

  • Trainer Name * Required
  • Address * Required
  • I certify that I am owner of the above described animal, and have authority to authorize care. I understand that all fees are due at the time that services are performed. AEVS reserves the right to discontinue service to anyone with an outstanding account balance. A $25 fee will be assessed to any returned checks. Any balance held over 60 days is subject to 3% finance charges.
  • Owner Name * Required