New Client Information

New Client Information

IMPORTANT: Please make an appointment prior to completing New Client forms. Call Blue Springs Animal Hospital & Pet Resort at 816-229-1544 or book online using the link on our website.
Contact Information

Please provide current and accurate contact information. Our doctors may need to call you for lab results or other important patient information. We send appointment confirmations and reminders by email and/or text message. We will not spam or share your email or cell phone.
Date*

MonthDayYear
Date
Name*

First NameLast Name
Primary Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Spouse / Significant Other / Alternate Contact

First NameLast Name
Spouse / Significant Other / Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*

Confirmation Emailexample@example.com
WebsiteSign/LocationUsed Us PreviouslyPersonal ReferralOther
- Whom may we thank?
- Pet Information
- Patient Name*
- DogCatOther
- If you have an exotic pet, such as a bird, reptile, or small mammal like a rabbit or hamster, please complete the New Patient Exotic Pet Form for each exotic pet in addition to this new client form. The exotic pet form will collect specific history information for your exotic pet and help the doctor provide better care. Thank you!
- FemaleFemale SpayedMaleMale Neutered
- Patient Breed*
- Patient Color*
- Patient Birthday or Age*
- Last Vaccinated?*
- YesNo
- Patient 2 Name*
- DogCatOther
- If you have an exotic pet, such as a bird, reptile, or small mammal like a rabbit or hamster, please complete the New Patient Exotic Pet Form for each exotic pet in addition to this new client form. The exotic pet form will collect specific history information for your exotic pet and help the doctor provide better care. Thank you!
- FemaleFemale SpayedMaleMale Neutered
- Patient 2 Breed*
- Patient 2 Color*
- Patient 2 Birthday or Age*
- Patient 2 Last Vaccinated?*
- YesNo
- Patient 3 Name*
- DogCatOther
- If you have an exotic pet, such as a bird, reptile, or small mammal like a rabbit or hamster, please complete the New Patient Exotic Pet Form for each exotic pet in addition to this new client form. The exotic pet form will collect specific history information for your exotic pet and help the doctor provide better care. Thank you!
- FemaleFemale SpayedMaleMale Neutered
- Patient 3 Breed*
- Patient 3 Color*
- Patient 3 Birthday or Age*
- Patient 3 Last Vaccinated?*
- Medical Records
  
  If possible please upload or bring previous medical records including vaccine history, lab work and Xrays to your visit. Also bring any medications your pet is currently taking or has previously taken.
- Note: Only upload records on this form for dogs or cats. For an exotic pet such as a bird, reptile, or small mammal like a rabbit or ferret, please upload their medical records when completing the New Patient Exotic Pet Form.
- Upload Records
  
  Cancelof
- YesNo
- Note: Only select Yes on this question if you are seeking a second opinion for a dog or cat. For an exotic pet such as a bird, reptile, or small mammal like a rabbit or ferret, select NO on this form. You will have an opportunity to answer these questions on the New Patient Exotic Pet Form.
- Describe the problem that is prompting you to seek a second opinion*
- How long has this been a problem?*
- How many other veterinarians have treated your pet for this problem?*
- Describe any previous diagnostic tests and the results if you know them.
- List any previous medications or treatments for this problem and describe how your pet responded.
- Payment Policy
- Blue Springs Animal Hospital accepts
- Credit or Debit CardPersonal CheckCashOther
- YesNo
- Insurance Company
- YesNo
- Notes or Special Instructions
- Please verify that you are human*
- Should be Empty:

New Client Information

Contact Information

Pet Information

Medical Records

Payment Policy