Start your journey in seconds

Please take a few moments to fill out our New Patient Form using one of the options below if your pet is a new patient at Jefferson Animal Hospital.

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Multiple ways to fill out the new patient form

Complete Form

Complete and submit the online form below.

Complete Form

Print & Complete

Please download and complete the patient form before your visit to help us serve you more efficiently.

Complete on Arrival

If you prefer, fill out the form when you get to our hospital.

View Open Hours

Owner Information

Owner First Name *

Owner Last Name *

Phone Number *

Email *

Address *

City *

Zip Code *

Apt/Unit

County *

Spouse/Partner

Secondary Number

How did you learn about our practice? *

Frequently Asked Questions About Patient Forms

What our clients say

Holly C.

Our family has been going to Jefferson Animal Hospital for several years. They are kind, compassionate, and knowledgeable. Their reception staff has always been courteous, responsive, and professional. The techs are loving and warm. The Doctors are patient and provide the best care for our pets. I recommend them with 100% confidence.

Book an Appointment at Jefferson Animal Hospital

New pets are always welcome at Jefferson Animal Hospital. Our friendly veterinary staff looks forward to providing our neighbors in Citrus Heights and surrounding communities with the veterinary care they need.

Book Online
Great Dane Dog