New Client Form

Thank you for giving us the opportunity to care for your pet. We’ll be happy to answer any questions you have about your pet’s health. To ensure the best care possible, please take the time to complete this form.

Co-Owner Name (first & last):

Co-Owner Phone Number:

Patient Information #1:

Pet's Name

Age / DOB

Species

Breed

Color

Sex

Lifestyle

Microchipped

Please list current prevention used

Heartworm
Flea/Tick

Current medication(s)

Describe your pet's diet

Patient Information #2

Pet's Name

Age / DOB

Species

Breed

Color

Sex

Lifestyle

Microchipped

Please list current prevention used

Heartworm
Flea/Tick

Current medication(s)

Describe your pet's diet

General Information

Previous Veterinarian and Phone Number

How did you hear about us?

Internet Search

Drive By

Client Referral

Other

If you were referred by a client, what is their name?

I understand that my pet’s picture may be used on social media sites.

YES, you can use my pet's photo on social media.

NO, do not use my pet's photo on social media.

Reason for your pet's visit:

I hereby authorize the veterinarian to examine, prescribe for, or treat the described pet(s). I assume the responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment. I authorize a service charge to be placed on my account if I fail to pay for services rendered at the time of treatment.
*

I have read and understand the above statement

Animal Care Center of Hays County Veterinary Forms