717-533-6745
ahccreception@gmail.com



Home
About Us
- Our Team
- Reviews
Payment Options
Services
Client Information
Contact
Appointment

717-533-6745
ahccreception@gmail.com



Home
About Us
- Our Team
- Reviews
Payment Options
Services
Client Information
Contact
Appointment

A cute gray and white kitten standing on hind legs

New Client Form

Save time at your first appointment! Complete your required new client form online before your visit.

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Pet Owner Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Preferred Phone *

Can we text this phone number? *

Yes
No

Cell Phone

Work Phone

Email *

Spouse/Co-Owner

Cell Phone #

How did you hear about us?

Pet Information

Pet's Name *

Age/Date of Birth *

Species (dog, cat, etc.) *

Breed *

Color

Microchip #

Sex *

Male
Neutered Male
Female
Spayed Female

Current Medications:

Known Medical Conditions/Allergies

Location of previous medical records

Any other pets in your home?

Yes
No

If yes, how many?

We frequently share photos of our patients and team members on our social media pages (owner's name and info not included). Do we have permission to post your pet's photos?

Yes
No

Second pet

Yes
No

Pet's Name *

Age/Date of Birth *

Species (dog, cat, etc.) *

Breed *

Color

Microchip #

Sex *

Male
Neutered Male
Female
Spayed Female

Current Medications

Known Medical Conditions/Allergies

Location of previous medical records

We frequently share photos of our patients and team members on our social media pages (owner's name and info not included). Do we have permission to post your pet's photos?

Yes
No

Third pet?

Yes
No

Pet's Name *

Age/Date of Birth *

Species (dog, cat, etc.) *

Breed *

Color

Microchip #

Sex *

Male
Neutered Male
Female
Spayed Female

Current Medications

Known Medical Conditions/Allergies

Location of previous medical records

We frequently share photos of our patients and team members on our social media pages (owner's name and info not included). Do we have permission to post your pet's photos?

Yes
No

Fourth pet? *

Yes
No

Pet's Name *

Age/Date of Birth *

Species (dog, cat, etc.) *

Breed *

Color

Microchip #

Sex *

Male
Neutered Male
Female
Spayed Female

Current Medications

Known Medical Conditions/Allergies

Location of previous medical records

We frequently share photos of our patients and team members on our social media pages (owner's name and info not included). Do we have permission to post your pet's photos?

Yes
No

Fifth pet? *

Yes
No

Pet's Name *

Age/Date of Birth *

Species (dog, cat, etc.) *

Breed *

Color

Microchip #

Sex *

Male
Neutered Male
Female
Spayed Female

Current Medications

Known Medical Conditions/Allergies

Location of previous medical records

We frequently share photos of our patients and team members on our social media pages (owner's name and info not included). Do we have permission to post your pet's photos?

Yes
No

In order to facilitate an increasing number of patients, to maintain fair cost of services, and to keep our services at the highest level of quality, we cannot extend credit out of our office. Please understand that payment in full is due at the time of service. We may also require a deposit for major procedures. To help you obtain your financial responsibility the following payment options are accepted: cash, debit, Visa, Mastercard, Discover, Care Credit and personal check. *

As the financially responsible party, I understand and agree to pay for all services rendered that I authorize and I certify that I am eighteen years of age or over.

Email

We Proudly Serve the Pets of Hershey, PA, and Beyond.

Our mission is to provide exceptional veterinary care that supports pets’ quality of life and their place in your family. In developing care for all companions, we first acknowledge the unconditional love and companionship they freely give.

Have a Question?

Please complete our online form and a member of our team will get back to you as quickly as possible.

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Location

948 East Chocolate Avenue
Hershey, PA 17033

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Contact Information

Phone: 717-533-6745
Email: ahccreception@gmail.com

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Hours

Monday-Friday: 7 AM – 6:30 PM
Saturday: 8 AM – 12 PM
Sunday: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

Email

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