Client Information

Please complete all information prior to your visit. If you have any questions, please give us a call at 636-322-4052. Thank you!

Your Name (first and last)*

Additional person(s) authorized to make medical decisions:

Street address (number, street)*

City*

State*

Zip code*

County

Primary Phone number*

Format: (000) 000-0000.

Mobile/CellularHome/LandlineWork

Secondary Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Mobile/CellularHome/LandlineWork

YesNo

Email address*

How did you hear about us? *

Pet Name*

DogCat

Pet Breed*

Pet Age or Date of Birth*

Pet Color*

YesNo

Anything else you'd like us to know?

YesNo, I will bring a copy of records with mePet has no previous vet

Who is your previous vet?*

YesNo

If you have other pets, please tell us their age, breed, sex, name, and color.

Please note, we do not work with outside online pharmacies (ie: Chewy, 1800PetMeds, etc). We have had issues with their business practices and have chosen to discontinue our relationship with them. However, we are happy to provide you with a written prescription that you can send in, if you choose to utilize these companies. Initials:*

Your appointments and well-being are very important to us. We understand that sometimes, unexpected delays can occur, making schedule adjustments. If you need to reschedule your appointment, we respectfully request at least 24 hours notice. Any cancellation or reschedule made less than 24 hours in advance will result in a cancellation fee. For surgeries, the amount of the fee will be equal to 50% of the low end of the estimate. For regular appointments, the fee is $25. If you are more than 10 minutes late for your service, we may not be able to accommodate you. In this case, the same cancellation fee will apply. We will do our very best to reschedule your service for another time that is convenient to you. In the event of a true, unavoidable emergency, all or part of your cancellation fee may be applied to future services. Initials :*

Payment is expected at the time of service. We accept cash, credit/debit cards, CareCredit, or Scratchpay. We do not accept checks. Initials:*