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
Why did you choose us?*

WebsiteSign/LocationUsed Us PreviouslyPersonal ReferralOther
- Whom may we thank?
- Pet Information
- Patient Name*
- Patient Species*
  
  DogCatOther
- If you have an exotic pet, such as a bird, reptile, or small mammal like a rabbit or hamster, please complete an Exotic Pet New Patient form. This provides important information unique to exotic pets that will help our veterinarians provide the best care.
  
  A link to that form will be provided on the confirmation page that will pop up after you submit this form. It can also be found on the New Client page of our website. Thank you!
- Patient Sex*
  
  FemaleFemale SpayedMaleMale Neutered
- Patient Breed*
- Patient Color*
- Patient Birthday or Age*
- Last Vaccinated?*
- Do you have another pet to add?*
  
  YesNo
- Patient 2 Name*
- Patient 2 Species*
  
  DogCatOther
- If you have an exotic pet, such as a bird, reptile, or small mammal like a rabbit or hamster, please complete an Exotic Pet New Patient form. This provides important information unique to exotic pets that will help our veterinarians provide the best care.
  
  A link to that form will be provided on the confirmation page that will pop up after you submit this form. It can also be found on the New Client page of our website. Thank you!
- Patient 2 Sex*
  
  FemaleFemale SpayedMaleMale Neutered
- Patient 2 Breed*
- Patient 2 Color*
- Patient 2 Birthday or Age*
- Patient 2 Last Vaccinated?*
- Do you have another pet to add?*
  
  YesNo
- Patient 3 Name*
- Patient 3 Species*
  
  DogCatOther
- If you have an exotic pet, such as a bird, reptile, or small mammal like a rabbit or hamster, please complete an Exotic Pet New Patient form. This provides important information unique to exotic pets that will help our veterinarians provide the best care.
  
  A link to that form will be provided on the confirmation page that will pop up after you submit this form. It can also be found on the New Client page of our website. Thank you!
- Patient 3 Sex*
  
  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. Medical records for exotic pets can be uploaded when you complete the Exotic Pet New Patient Form.
- Upload Records
  
  Cancelof
- Is this appointment for a 2nd opinion on your pet's medical condition?*
  
  YesNo
- Note: Only select Yes on this question if you are seeking a second opinion for a dog or cat. Second opinion information for exotic pets will be collected when you complete the Exotic Pet New Patient 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
- Our payment policy is "payment when services are rendered." How will you be paying for services at your appointment?*
  
  Credit or Debit CardPersonal CheckCashOther
- Does your pet have pet health insurance?*
  
  YesNo
- Insurance Company
- We require an adult who is financially responsible for the pet to be present at the appointment. I am 18 years or older and I am financially responsible for this pet.*
  
  YesNo
- Notes or Special Instructions
- Please verify that you are human*
- If you have an exotic pet, please click below to submit this form. A webpage will come up to confirm your submission. Look for a link to the Exotic Pet New Patient Form on that webpage. If you do not see a link to the form, please visit our website at bluespringsanimalhospital.com and click on New Client for a link to the form. Thank you!
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New Client Information

Contact Information

Pet Information

Medical Records

Payment Policy