Register a pet with Our House Call Vet to make an appointment

Registration Form

For new clients, or existing clients with a new pet, please fill out ONE registration form for EACH PET. ie. 2 pets, 2 forms.

Please fill out ALL FIELDS of the form, in order for it to process correctly.

If you do not hear back from us within 4 business hours
(Monday - Friday 9-5), please e-mail us at [email protected] or call 201-803-7705

* Indicates required field

Name *

First

Last

What search word did you use? Or who referred you? *

Who is your regular veterinarian? *

Pet Owners Address *

Line 1

Line 2

City

State

Zip Code

Country

If you live in an apartment/ condo/etc, please give us the building number and advise us on where to park. *

Home Phone Number - INCLUDE DASHES *

Cell Phone Number - INCLUDE DASHES between area code, prefix and suffix *

Email *

Pet's Name *

Choose One Please *

Dog Cat

If you have a cat, is it declawed? *

Sex *

Male Female I don't know

Is your pet spayed or neutered? *

Yes No I don't know

Is your pet microchipped *

Yes No I don't know

Pet's Birthdate *

Breed *

Color *

Weight - please approximate if you do not know *

Date of Last Rabies Vaccination *

List ALL other vaccinations, AND the month/year they were given (ex.DHPP 4/2017, Bordetella 4/2017, Lyme 4/2017, FVRCP 3/2016, Felv 3/2016, etc) *

Brief reason for visit *

Has your pet ever bitten, growled,or scratched at anyone (including a Veterinarian)? Has your pet ever required a muzzle at the vet? Feel free to explain the circumstances. *

I agree to pay in full, with cash or a check, for services at the time services are rendered. *

Yes No

CLIENT POLICY Dr. Mazzola and staff are happy to assist you and your pet in a mutually enjoyable and respectful working relationship with healthy boundaries. Dr. Mazzola is a proud supporter of Not One More Vet and reserves the right to refuse service at her discretion. AGGRESSIVE PET POLICY Due to some staff injuries and safety purposes OHCV has a no aggressive pet policy. We reserves the right to decline a physical exam if a pet displays aggressive behavior, such as growling, snarling, lunging or attempting to bite. If the pet is deemed to be aggressive by the veterinarian, the client agrees to pay in full, the house call and travel fee and a veterinarian consultation fee. OHCV does not accept pets with a history of aggression or in need of sedation for exams. Dr. Mazzola reserves the right to refuse service at her discretioPREVIOUS RECORD AUTHORIZATION: I authorize Our House Call Vet to contact my previous veterinarian to obtain records, doctors notes, and lab test results. CONTACTING OHCV: Due to the nature of this practice, Dr. Mazzola’s preferred method of contact is email as they are either actively with a patient or actively traveling for housecalls. TELEMEDICINE APPOINTMENTS are available for continued correspondence and care after the in person appointments, and will be charged according to the amount of time involved in the telemedicine consult. PRACTICED POLICY AGREEMENT I have read the Client Policy, Aggressive Pet Policy, etc above and agree to the terms. *

I agree I disagree

Submit