New Client and Patient Form

5900 Jack Finney Blvd.

Greenville, TX 75402

(903) 454-6222

www.turtlecreekvmc.com

New Client and Patient Form
Type a question
Does your pet already have an appointment scheduled at our hospital? If yes, please enter date/time of your appointment. If no, please call to schedule after submitting form.
Pet Owner's Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Driver's License Number
State
Email - Your email address will be used as a primary venue of contact for your pet's health reminders. We DO NOT send out paper reminder cards.
example@example.com
Mobile Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Which number should be listed as your primary form of contact?
Please list any additional authorized individuals you would like included on your account. Please be advised - these individuals will have access to account information and possess the ability to authorize medical treatments and charges.
- Do you authorize our hospital to send text messages for regarding your pet's care?
- Do you authorize our hospital to post photos on social media of your pet for educational and/or interactive purposes?
- How did you hear about our hospital?
  
  Other
- Pet Information
- Pet's Name
- Pet's Age or DOB
- Species
- Pet's Gender
- Breed
- Color
- What hospital can we contact to obtain your pet's previous medical records?
- To maintain compliance with state law, all pets must have a record of current Rabies immunization to receive services at our hospital. If your pet is not current, a Rabies immunization will be administered at your expense. Please initial below to verify this requirement has been understood and accepted.
- Does your pet have any medical conditions, such as allergies, drug or vaccine reactions, heart conditions, etc?
- Please list all medications your pet currently takes, including supplements:
- Is your pet microchipped?
- Does your pet have pet insurance? If yes, what company do you use?
- Please indicate your pet's typical diet:
- Does your pet eat table food or scraps?
- Pet Information
- Pet's Name
- Species
- Pet's Age or DOB
- Pet's Gender
- Breed
- What hospital can we contact to obtain your pet's previous medical records?
- To maintain compliance with state law, all pets must have a record of current Rabies immunization to receive services at our hospital. If your pet is not current, a Rabies immunization will be administered at your expense. Please initial below to verify this requirement has been understood and accepted.
- Does your pet have any medical conditions, such as allergies, drug or vaccine reactions, heart conditions, etc?
- Please list all medications your pet currently takes, including supplements:
- Is your pet current on heartworm preventative? If yes, what brand do you use?
- Is your pet microchipped? If yes, what is their microchip number?
- Does your pet have pet insurance? If yes, what company do you use?
- Please indicate your pet's typical diet:
- What brand of food does your pet typically eat?
- Does your pet eat table food or scraps?
- Cancellation / No Show Policy
- At Turtle Creek Veterinary Medical Center, we are dedicated to providing exceptional care for your pet and ensuring that all clients have access to timely veterinary services. In order to maximize our ability to serve all pets efficiently, we respectfully ask that you adhere to the following appointment policy.
  - No-Show and Late Cancellation Policy:
    We kindly request that all cancellations or rescheduling of appointments be made at least 24 hours in advance.
    
    Failure to provide at least 24 hours notice or failure to attend a scheduled appointment will be considered a "no-show."
  - Policy on No-Shows and Late Cancellations:
    Following the first instance of a no-show or late cancellation, a non-refundable reservation fee equivalent to the exam fee will be required to schedule future appointments.
    
    This reservation fee will be applied to the cost of the appointment but will not be refunded if the appointment is missed or cancelled with less than 24 hours notice.
    
    We understand that unforeseen circumstances may arise, and we are happy to assist you in such cases. However, missed appointments prevent us from providing care to other pets in need and disrupt our ability to maintain an efficient schedule.
- Please initial below to verify the Cancellation / No Show policy has been understood and accepted.
- Financial Policy
- Thank you for choosing us as your veterinary health care provider. We are committed to your pet's treatment being successful and as cost effective for you as possible. The following is a statement of our Financial Policy. We ask that you read and sign below.
  - Full payment is due a the time service is rendered. We accept cash, debit, VISA, MasterCard, Discover, Care Credit, and Scratchpay. WE DO NOT ACCEPT CHECKS. If there are any questions regarding fees or charges, please inform a member of our team before any services are performed.
  - Before any pet is admitted to the hospital, a deposit will be required before services are rendered with the BALANCE DUE IN FULL UPON RELEASE.
- Signature
- Printed Name:
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Should be Empty: