Name *

First

Last

How Did You Hear About Us?

Other

Emergency Contact Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone *

I consent to SMS reminders for appointments, bloodwork results, and clinic communication. *

Yes
No

Emergency Contact Phone

Work Phone

Email *

Comments

Patient Information

Patient Name *

Patient Sex *

the Appointment Office

Patient Species *

Patient Breed *

Patient Color *

Is Your Pet Up-to-Date on Rabies? *

Yes
No

Patient Rabies #

Is Your Pet Currently on Prevention? *

Yes
No

What Prevention Is Your Pet On? *

Example: Bravecto Flea & Tick, Sentinel Spectrum Heartworm & Intestinal Parasite

List Any Current Medications Your Pet Is On:

Allergies

Birthdate or Estimated Age *

Age Is Estimated *

Yes
No

Do You Have a Current or Past Family Veterinarian? *

Yes
No

Current or Past Family Veterinarian Office *

We may need this information to get pertinent records.

Upload a Picture of Your Pet

Click or drag a file to this area to upload.

THIS IS NOT REQUIRED BUT RECOMMENDED FOR OUR RECORDS

I Give Permission to Our Office to Post Social Media Pictures of My Pet *

Yes
No

PLEASE READ THE FOLLOWING CAREFULLY:

Payment IN FULL is due at the time your pet is discharged.
I will be provided with a written estimate of charges.
A 100% deposit will be required if your pet is hospitalized. If your pet needs to have surgery or a procedure, the HIGH end of the estimate must be paid upfront.
I authorize the veterinarians to perform treatment & diagnostics for my pet.
I assume responsibility for ALL charges incurred in the care of this animal.
We have a strict policy to not allow returns of medications once they have been dispensed and removed from the hospital.

Payment IN FULL is due at the time your pet is discharged. I will be provided with a written estimate of charges. A 100% deposit will be required if your pet is hospitalized. If your pet needs to have surgery or a procedure, the HIGH end of the estimate must be paid upfront. I authorize the doctors to perform treatment & diagnostics for my pet. I assume responsibility for ALL charges inccured in the care of this animal. We have a strict policy to not allow returns of medications once they have been dispensed and removed from the hospital.

I Agree to the Above Statements

Appointment Type *

This Is an Urgent Care/Emergency Visit/Sick Patient
This Is A Wellness Visit

Signature *

Clear Signature

Use your mouse or finger to draw your signature above

I Have Another Pet to Add - Wellness Only Please

Yes
No

If You Have Another Sick/Urgent/Emergent Case - Please Fill Out the Entire Form Again Once Submitting

Phone

Email

Hours

Phone

Phone

Fletcher, NC

New Client Form

New Client Form

New Client Form

Patient Information

Book an Appointment

Have a question?

Location

Contact Information

Hours