Anthony J. Smith, DVM
Hercules, CA 94547
© Copyright 2017 Rainbow Bridge Vet Services
New Patient Registration Form
Please complete the form below to begin the process of setting up an appointment for your pet. Feel
free to contact us via phone or email if you have any questions or difficulty completing the form.
(* Required Field)
(First & Last)
Is there anything we should know about finding your place or parking?
Who else may be present? (Family, friends, other pets)
Your Pet's Information
Pet's Main Ailment
Pet's Regular Veterinary Hospital(s)
What days and/or times would work best for an appointment?
What type of aftercare would you like for your pet?
Private Cremation with ashes returned
Group Cremation (no ashes returned)
None (Will not need my pet's body taken afterward)
Questions, comments, or feedback: