New Client Form

(右上角转换语言， Elija el idioma en la esquina superior derecha)

WE KNOW YOUR PET’S HEATH IS IMPORTANT AND WE THANK YOU FOR TRUSTING US TO CARE FOR THEM. TO HELP US PROVIDE THE BEST CARE POSSIBLE, PLEASE TAKE A FEW MOMENTS TO FILL OUT THIS FORM COMPLETELY. THANK YOU!

Owner's name*

First NameLast Name

Spouse/Co-Owner/Sig. Other

Cell Phone #*

Spouse/Co-Owner/Sig.Other Cell Phone Number

Area CodePhone Number

Preferred Phone Number to Contact?

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

EMAIL ADDRESS*

example@example.com

How did you hear about our clinic?

If referred by friends, please enter their name so we can thank them

Please enter details of your pet*

	Pet #1	Pet #2	Pet#3	Pet#4
Name
Breed
Age
Color
Sex (M/F)
Spayed/Neutered (Y/N)?
Previous illness/surgery list
Special diet/meds/Allergy list

I confirm that I am at least 18 years of age and legally authorized to make medical and financial decisions for my pet(s). I understand that any individual listed on the account, or who brings the pet in for care, is also authorized to make such decisions unless otherwise specified in writing. I hereby authorize the veterinarian to examine, prescribe for, and/or treat my pet(s). I assume full financial responsibility for all approved services and charges incurred for the care of all pets listed under my account. I understand that payment is due at the time services are rendered, and that a deposit may be required for surgical procedures or hospitalization.

Name of Previous Veterinary Clinic

Phone number of prior vet clinic

Cancellation/Late Policy

We understand that life can be unpredictable, and sometimes plans change. However, missed appointments prevent us from helping other pets in need.

Cancellation Policy: If you need to cancel or reschedule your appointment, please call or text us at least 6 hours before your scheduled time. No-call / no-show or cancellations made with less than 6 hours’ notice will require a $25 deposit to schedule your next appointment. This deposit will be applied toward your next visit but is non-refundable if you miss or cancel that appointment without proper notice.

Late Policy: If you arrive more than 15 minutes past your scheduled appointment time, you may choose one of the following options:

1. Convert to a drop-off appointment at no additional cost.
2. Continue with a regular appointment by paying a $15 late fee.
3. Reschedule your appointment at no cost.

Thank you for helping us provide timely care to all our patients.

Rabies Vaccine Policy

Rabies vaccination is required by Texas state law for all dogs and cats. If your pet is not current on its rabies vaccine at the time of the visit, we are legally obligated to update it during the appointment, provided your pet is healthy enough to receive it. This policy helps protect your pet, our staff, and the community.

Rabies vaccine helps

- Protect public health by preventing human exposure to a deadly disease
- Control wildlife-to-pet transmission, since wildlife (bats, skunks, raccoons, foxes) can carry rabies
- Ensure pets act as a barrier, not a bridge, between wildlife and humans
- Reduce the need for costly quarantine or euthanasia if a pet bites someone while unvaccinated
- Because of how dangerous rabies is, the law treats vaccination as a critical public-safety measure—not just a routine pet vaccine.

If your pet has a medical condition that prevents him/her from getting rabies vaccine please elaborate here

SIGNATURE*

Please Print Name*

First NameLast Name

DATE OF SIGNATURE*

Date

PET HEALTH HISTORY

AUTHORIZATION