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516-483-7007

779 Peninsula Blvd.,
Hempstead, NY 11550

Pet Emergency at Animal Medical Hospital Animal Medical Hospital AAHA Accredited Visit our sister hospital in Queens

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HomePet OwnersNew Clients

Welcome New Clients! New Client Form

Please do not use this form if your pet is experiencing an emergency. If your pet is experiencing an emergency call us right away at 516-483-7007 and we will prepare for your arrival.

CLIENT INFORMATION:

Your First Name [*] Required Field

Your Last Name [*] Required Field

Address [*] Required Field

City [*] Required Field

State [*] Required Field

Zip [*] Required Field

Home Phone

Cell Phone [*] Required Field

Work Phone

Email Address [*] Required Field (We can email exam report cards and important notices.)

Spouse’s Name

Spouse Cell

Spouse Work

Preferred Contact Method?

Cell Phone Service Provider

How did you hear about us?

Other (please name)


FINANCIAL INFORMATION

Credit Card

I have Pet Health Insurance

I do not have Pet Health Insurance (Please tell me about it!)

I hereby authorize the doctors and staff to diagnose, prescribe for, and treat the above described pet. I assume all responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time services are rendered. In the case of hospitalization, I will be required to leave a substantial deposit. The remaining balance must be paid in full at the time of discharge of the pet. I authorize photos and video to be taken of my pet’s care for training, website, and educational purposes.

Please present a valid drivers license or photo id at the time of check-in.


PET INFORMATION

Pet Name

Birth date/Approx age

Type of Pet?

Breed

Color

Sex

Neutered/Spayed

Indoor/Outdoor

Is your pet Microchipped?

Where did you get your pet?

When did you get your pet?

Approx. age when acquired

Past Veterinarian

Would you like us to contact past vet for medical history?

Approx. date of last veterinary examination

Last vaccinations (date)

How many, and what type of pets do you own?

Dog(s)

Cat(s)

Bird(s)

Other (specify)

Kindly list any previous medical or surgical problems and current medications

Is your pet current taking Heartworm Preventative?

Name of Meds

What flea and tick protection are you currently using on your pet(s)

What brand of food is you pet currently eating

How much do you feed daily

Does your pet get any table scraps and how often

Describe your pet’s temperament (personality)

Reason for visit

The individuals listed below are authorized representatives to act on your behalf in cases dealing with the pet listed above. They are authorized to obtain medical information regarding your pet, to admit and pick up your pet from our facility, and give verbal and/or written authorization to perform medical services and procedures. The individuals listed below are required to show photo identification when acting as your authorized representative.

Authorized representative #1 (include name, relatinship and contact number)

Authorized representative #2 (include name, relatinship and contact number)

Authorized representative #3 (include name, relatinship and contact number)


  • Whitestone, Flushing, Queens, Little Neck, Great Neck and Bayside NY
  • What a thorough, caring, and knowledgeable staff! I felt like Scarlett (my cat) got compassionate and focused care. My neighbor raved about Dr. Wyler and now I know why...but the entire staff displayed over the top attentiveness! Go there, everyone!
  • I have been going to Animal Medical Hospital for many, many years, and have had several pets treated by Dr. Douglas Wyler. He has always given them the best of care, and keeps me informed about what is going on with them. He and all the staff are just wonderful - Lisa, especially, has been so helpful! I would heartily recommend them to anyone looking for a caring and knowledgeable veterinarian!
  • We have been going to Whitestone Vet Care for over 10 years now. Our dog Twister is now 11 years old and due to the wonderful care she has received from Dr.Wyler and his staff over the years, she is as healthy and happy as a spring chicken.
  • This is my 1st dog and I just love this place. They are willing to answer all my questions and concerns. I never have to wait long and everyone is so loving and caring. I feel confident my Dog Max is being care for well.
  • Very satisfied with the care my cat, Sunkiss received. The technicians, veterinarian, and staff, were very professional, friendly, and concerned about her problem. Used them for my other tabby, Tiger; who had a grocery list of problems; but lived a comfortable life to the age of 16.5 years.

HOURS OF OPERATION:
Mon & Thu: 8am - 8pm
Tue, Wed, Fri: 8am - 6pm
Sat: 8am - 4pm


VETERINARY SERVICES

Veterinary Services at Animal Medical Hospital

DISCOUNTS & PROMOTIONS

Veterinary Promotions at Animal Medical Hospital

FREE VACCINES FOR LIFE

Free Vaccines For Life

CARE TO SHARE PROGRAM

Care to Share Program