New Client Form

Welcome to Glades Pike Veterinary Hospital! Complete the form below or download the form to complete it at your convenience.

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Welcome to the Glades Pike Family!

We are SO happy you’re here! We look forward to meeting you and your fur children in the near future, and hope to a build lasting relationship with you. Please feel free to check out all of the services, with many more coming soon, that we offer. Have questions? Feel free to reach out to us. We are happy to help in any way that we can!

Before your first visit, we ask that you fill out one of our new patient forms prior to your appointment to help us better serve you. For your convenience, you can fill out online or print and bring with you! Can’t do either? No problem! We will have hard copies available for you at the office! Additionally, if you could bring any previous vet records for your pet, we would greatly appreciate it!

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you hear about us?

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

Glades Pike Veterinary Hospital will take photos of you and/or your pet as needed for our medical records. We ask your permission to take additional photos to copyright, use, and publish in print and/ or electronically. We may use such photographs for any lawful purposes including but not limited to: publicity, marketing materials, advertising, website content, and social media content. *

GPVH may use photos of me and/or my pet for uses explained above.
GPVH may not take photos of me and/or my pet beyond medical records needed.

I, the owner or authorized agent for the fore-described pet(s), as primary pet parent, am at least 18 years of age and accept full responsibility for all costs incurred. I understand that, as a condition of treatment by this hospital, all payments must be made at time of service. In the event that this account should go unpaid, I will be subject to the costs of collections, including attorney fees and/or collection agency fees. *

I have read and understand.

Signature *

Please type your name

Date *

Comment

Proudly caring for the pets of the Laurel Highlands and beyond.

It is our mission to partner with our clients to nurture and preserve the human-animal bond by providing compassionate, expert, and affordable veterinary care from your pet's first adventure throughout a long and healthy life.

Contact

Phone: 814-444-6809
Fax: 814-444-6843
Email: info@gladespikevet.com

Location

917 W. Main St.
Somerset, PA 15501

Hours

Mon - Tue: 8 AM - 6 PM
Wed: 8 AM - 8 PM
Thu - Fri: 8 AM - 6 PM
Sat - Sun: Closed

Have a question?

Complete the form below and we'll be in touch with you shortly.