New Patient Online Appointment

New Patient

Online Appointment
Thank you for booking your appointment online.

Please answer the following questions to complete a new patient record for your pet at Blue Springs Animal Hospital & Pet Resort.
Client Name*

First NameLast Name
Primary Phone*
Please enter a valid phone number.Format: (000) 000-0000.
- 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 the New Patient Exotic Pet Form instead of this form. This New Patient Form is only for dogs and cats. Thank you!
- Patient Sex*
  
  FemaleFemale SpayedMaleMale Neutered
- Patient Breed*
- Patient Color*
- Patient Birthday or Age*
- Last Vaccinated?*
- Do you have another new pet to add?*
  
  YesNo
- Patient Name*
- Patient Species*
  
  DogCatOther
- Patient Sex*
  
  FemaleFemale SpayedMaleMale Neutered
- Patient Breed*
- Patient Color*
- Patient Birthday or Age*
- 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.
- Upload Records
  
  Cancelof
- Is this appointment for a 2nd opinion on your pet's medical condition?*
  
  YesNo
- 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*
- Should be Empty:

New Patient

Thank you for booking your appointment online.

Pet Information

Medical Records

Payment Policy