New Client | New Patient Form
  • New Client | New Patient Form

  • Welcome to Animal Care Express Services!

    Thank you for choosing our services for your pet! Please take a moment to fill out the form below.
  • Client Information

    Client Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Co-Owner/Spouse Information

    Co-Owner/Spouse Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Pet's Information

    Pet's Information

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  • Additional Pet Information

    Additional Pet Information

    *Form will appear when yes is selected
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  • Patient History

    Patient History

  • Medications Your Pet Is Currently Taking

    Medications Your Pet Is Currently Taking

  • Referring Veterinarian Information

    *Required for all medical services*
  • Photo Release

    Photo Release

  • Please Sign The Following Authorization

    Please Sign The Following Authorization

    By signing and submitting, I agree to the following:
  • I hereby declare that I am the legal owner of the pet given its name above and give my consent for my pet to participate in all activities conducted by Animal Care Express Services.

    I hereby authorize and direct Animal Care Express Services and its staff to perform services, treatments, and/or administration of medications as prescribed by my veterinarian.

    It is expressly understood that Animal Care Express Services cannot make any diagnoses, assessments, treatments plans, discuss the interpretation of test results, and/or change orders of a treatment plan. Furthermore, it is understood that Animal Care Express Services is acting under my veterinarian's indirect supervision within my home.

    I understand that if my pet is known to have aggression of any kind or normally requires heavy sedation for any treatments then we will be required to have services performed through my local veterinarian.

    I understand that Animal Care Express sevices is not a groomer and does not offer elective/styled grooming. Baths are not included. The services are offered as a medical need for my pet.

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