Skip to Main Content

New Patient Form

If this is your pet's first time at Rockland Veterinary please complete our New Patient Form via any one of the following methods.

Option 1

Complete Online

Fill out and submit the following online form.

Option 2

Complete on Arrival

If you wish, complete the form at your appointment.

New Patient Form

Please fill out the new patient form for the hospital location of your appointment.


  • Hudson Valley

    Owner Information

    Emergency Contact

    Patient Information

    Primary Veterinarian Information

    Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Rockland Veterinary to release patient information to the primary care hospital or veterinarian.
    By submitting this form, I hereby authorize Rockland Veterinary to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Rockland Veterinary.

  • North Rockland

    Owner Information

    Emergency Contact

    Patient Information

    Primary Veterinarian Information

    Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Rockland Veterinary to release patient information to the primary care hospital or veterinarian.
    By submitting this form, I hereby authorize Rockland Veterinary to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Rockland Veterinary.

  • Pomona

    Owner Information

    Emergency Contact

    Patient Information

    Primary Veterinarian Information

    Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Rockland Veterinary to release patient information to the primary care hospital or veterinarian.
    By submitting this form, I hereby authorize Rockland Veterinary to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Rockland Veterinary.

We are now accepting new patients!

At Rockland Veterinary we are passionate about animals and enjoy helping cats and dogs feel well. Contact our vets in Hudson Valley, North Rockland or Pomona today to schedule your furry companion's first appointment! 

Locations

Contact