Schedule Appointment

Appointment Information Form

Thank you for choosing PetCare Animal Hospital for your pet's needs. Please fill out our intake form in entirety to ensure we can provide you and your pet with the best possible care.
Have you ever brought a pet to PetCare Animal Hospital before?*

YesNo
Owner's Name*

First NameLast Name
E-mail*
This will allow us to email invoice, estimates, medical records, etc.
Main Contact Number:*
Please use the number you would like our staff to contact you while you are in the parking lot.
Secondary Contact Number:
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How Would You Prefer To Be Contacted?*

Phone (Main Number)Phone (Secondary Number)Email

Pet's Name*
Pet's Species
Pet's Breed
Pet's Age
Pet's Sex
What type of food does your pet eat? Please specify brand, amount and frequency of feeding.*
Are you giving monthly heartworm preventative?*
Please indicate which heartworm product:
Are you giving monthly flea/tick preventative?*
Please indicate which flea/tick product:
Do you need refills on either of your pet's monthly preventatives?*
Is your pet on any chronic medications?*
Please indicate the medication, dosage, and frequency below:

Any Additional Information?
TREATMENT CONSENT: By signing this document, I declare I am the lawful owner of all listed pets and all information is true and correct to the best of my knowledge. I hereby authorize the veterinarian(s) of PetCare Animal Hospital to examine, prescribe for and/or treat my pet(s) to the best of their abilities. I assume responsibility for all charges incurred in the care of this animal and recognize that payment will be due upon completion of service. I acknowledge that medical information will not be released to anyone not indicated on this form without my express verbal and/or written consent.
Signature*

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Appointment Information Form