New Patient (Current Client) Form

1
Please Enter Your Information So We Can Fetch Your Account* This field is required.
First Name
Last Name
Phone Number
Email Address
2
Please Enter Your Pet's Information
Pet's Name
Pet's Age or Birthday
Please Select
Please Select
Canine
Feline
Species
Please Select
Please Select
Male
Male-Neutered
Female
Female-Spayed
Unsure
Sex
Breed
Color
3
Pet Food
What food does your pet currently eat?
How much do they receive each feeding?
How many times a day are they fed?
4
Does your pet receive table food?We're not here to judge! 😄 If your pet gets treats from the table, samples food dropped by the kids, raids the trash, or manages to convince family members to share a bite or two, please select "Yes."
Yes
No
5
Where does your pet spend most of their time?
Indoor
Outdoor
50/50
6
Is your pet ever groomed or boarded outside of your home?
Yes
No
7
Does your pet go on adventures outside of Texas?
Yes
No
8
Are there any other pets in the household?
Yes
No
9
Are there any small children in the household?
Yes
No
10
Optional: Tell Us About Your PetWe just like reading these and getting a good laugh. Select all that apply and/or feel free to include your own in 'Other'.
Certified Good Boy/Girl
Zero Thoughts, Just Vibes
Goofy Goober
Introvert (Secretly Wants To Be Friends)
Suspicious of Everything...especially plastic bags
Velco Pet
Never Met A Stranger
Certified Couch Potato
Zoomie Enthusiast
Neighborhood Watch Captain
Toy Destroyer Specialist
Food Motivated (Would Probably Sell The Family For A Snack)
Chief Barking Officer
Gentle Soul
Life of the Party
Treats Every Day Like Recess
Other
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Previous Veterinary Facility:* This field is required.Please enter N/A if your pet has never been to a vet before.
12
Has your pet had any prior illnesses, accidents, or surgeries?
Yes
No
13
Please explain previous illness, accident, or surgery
14
Has your pet ever shown aggression or fearfulness around strangers?* This field is required.Judgement Free Zone!
Yes
No
15
Please explain what triggers your pet to show aggression or fearfulness.
16
Does your pet take any medications or supplements?* This field is required.
Yes
No
17
Please list the medications/supplements your pet receives. Please include how much you give them and how often.
18
Does your pet receive heartworm or flea/tick preventatives?* This field is required.
Yes
No
19
Please list the preventions that your pet takes.
20
Does your pet have any known allergies or had an allergic reaction to vaccines?* This field is required.
Yes
No
21
Please tell us about their allergies or allergic event.If your pet had a vaccine reaction, please include what symptoms they exhibited.
22
Are there any topics you would like more information on or would like to discuss with the doctor? (Select all that apply.)
Heartworms and prevention
Flea life cycle and prevention
Vaccine schedules
Nutrition
Potty training
Allergies
Pain Management
Spay/Neuter
Dental hygiene and/or cleanings
New puppy/kitten with small children
None
Other
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Authorization To Treat* This field is required.I hereby authorize the veterinarian to examine, prescribe for, or treat the above-described pet. I assume all responsibility for all charges incurred in the care of this animal.
I have read and agree.
24
Photo Release * This field is required.If we happen to capture a photo that we think other pet lovers will enjoy just as much as you do, do we have your permission to share the image on our social media, website, and other forms of related media? We will never include sensitive or personal information.
Yes
No
25
Arrival* This field is required.For your protection and that of others, pets MUST be properly restrained by a leash or carrier upon arrival. If your pet requires special accommodations, please give us a call when you arrive so we can assist you and your pet.
I have read and understand.
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Late Arrival* This field is required.To ensure we have adequate time for all scheduled appointments and procedures, Shady Brook Animal Hospital operates primarily by appointment. We kindly ask that clients arrive on time for their scheduled visits. Clients arriving more than 10 minutes late may be asked to reschedule their appointment so that we can remain on schedule and provide each patient with the time and attention they deserve.
I have read and understand.
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Rescheduling/Cancellations* This field is required.We understand that unexpected situations arise and that appointments may occasionally need to be rescheduled or cancelled. As a courtesy, we do not charge cancellation or rescheduling fees. However, if appointments are frequently canceled or rescheduled, we may require a non-refundable deposit or ask that your pet be scheduled as a drop-off visit to help us best manage our schedule and accommodate all patients.
I have read and understand.
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Urgent/Emergency VisitsWe do take emergencies; however, these services may be subject to a higher fee schedule. For your convenience, we offer limited same-day appointments for urgent care sick patients; they fill up fast, so we recommend calling first thing in the morning.
I have reviewed and understand.
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Payment* This field is required.Payment is due in full at the time of service. We accept cash, debit, all credit cards, and pet insurance. We also offer CareCredit or Scratch Pay financing to help make the highest quality care accessible to all our patients. We do not offer in-house payment plans.
I have read and understand.
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Prescription Refills* This field is required.We are happy to fill your pet's prescriptions! Refill requests may be submitted by phone, text, email, or through our website. Please allow 24–48 hours for prescription requests to be reviewed, processed, and prepared for pickup. To avoid unnecessary trips, we kindly ask that you wait until our team has notified you that your prescription is ready before coming to the hospital. Please Note: Some prescriptions, including special-order medications, compounded medications, and controlled substances, may require additional processing time. If you choose to use an outside or online pharmacy, we are happy to provide a written prescription for you to pick up at the hospital. However, we do not authorize, call in, or process prescription requests received by phone or fax from online pharmacies. (Additional information regarding this policy will be covered in the 'Third Party Pharmacy Requests' section.
I have read and understand.
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THIRD-PARTY PHARMACY PRESCRIPTIONS & MEDICATION REQUESTS POLICY

At Shady Brook Animal Hospital, we understand there are many reasons clients may choose to purchase medications or preventatives from online retailers or outside pharmacies. We fully support your ability to choose where you obtain your pet’s medications and are happy to accommodate those requests.

To help ensure the safety and quality of your pet’s medications, we strongly encourage purchasing products only from properly accredited and certified veterinary pharmacies. However, if you choose to use an outside pharmacy, we want to make the process as simple and transparent as possible.

Our Prescription Process
Clients who choose to fill prescriptions through an outside pharmacy may request a written prescription from Shady Brook Animal Hospital.

Please note:

Written prescriptions must be picked up directly from our hospital.

We do not call prescriptions into outside pharmacies.

We are unable to email a copy of the written prescription.

We do not approve or process prescription requests submitted directly by online pharmacies via phone, fax, or electronic request.

This process allows us to better serve our patients while maintaining safe and accurate prescribing practices.

Why We Use This Process
We implemented this policy for several important reasons:

Patient Care Comes First

Our priority is caring for our patients and providing support to our clients. Managing large volumes of faxed and electronic refill requests from outside pharmacies can be time-consuming and may reduce the time available for patient care. In many cases, refill requests are generated automatically by online pharmacies rather than initiated directly by pet owners, which can create confusion and delays.

Improved Prescription Accuracy

Providing a written prescription creates clear documentation and reduces the risk of communication errors that can occur when information is relayed over the phone or through third-party systems.

Ordering Directly Through Shady Brook Animal Hospital
We encourage clients to consider purchasing medications directly from our hospital or through our online pharmacy. Our online store is regularly evaluated and compared with the most popular online pharmacies to offer our clients similar (or the same) pricing on most prescriptions.

When ordering through our clinic or online store:

No written prescription is required.

Orders are integrated directly with your pet’s medical record.

The medication supply chain is fully secure.

Products are stored, handled, and packaged according to manufacturer standards.

You are guaranteed authentic, name-brand products in the correct dosage and packaging.

Most importantly, medications purchased directly through Shady Brook Animal Hospital or our online store are backed not only by the manufacturer but also by us—your pet’s healthcare team.

We appreciate your understanding and thank you for allowing us to partner with you in your pet’s care.
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Third-Party Pharmacy Policy Acknowledgement* This field is required.I have read the third party pharmacy policy and understand that Shady Brook Animal Hospital will not approve prescription requests through third-party pharmacies such as Chewy, Costco, Amazon, etc. I understand that if I prefer to obtain my pet's medications via these platforms, I will need to pick up a written prescription from Shady Brook Animal Hospital and present it to the pharmacy of my choice.
I have read and understand.
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Mutual Respect Policy

Unfortunately, policies such as this one have become necessary in today's world. While the vast majority of our clients are kind, respectful, and appreciative of our team, we believe it is important to clearly outline our expectations to ensure a safe, welcoming, and professional environment for everyone.

At Shady Brook Animal Hospital, we are committed to providing a safe, welcoming, and respectful environment for our patients, clients, and team members.

Our staff are expected to treat every client and patient with professionalism, courtesy, compassion, and respect. In return, we expect all clients and visitors to extend the same level of respect to our team.

If a client ever feels uncomfortable, disrespected, or has concerns regarding the conduct of a staff member or another individual on our premises, we encourage them to speak with the Hospital Manager as soon as they feel comfortable doing so. We take these concerns seriously and are committed to addressing them professionally and respectfully.

Shady Brook Animal Hospital maintains a zero-tolerance policy for abusive, threatening, harassing, or disruptive behavior.

This includes, but is not limited to:

Verbal abuse, insults, or personal attacks

Threats of any kind, whether verbal, written, or physical

Intimidating, aggressive, or hostile behavior

Profanity or offensive language directed toward staff members or any other persons on the premise

Discriminatory, harassing, or inappropriate remarks

Physical violence, attempted violence, or threatening gestures

Damage to hospital property

Any behavior that compromises the safety, well-being, or ability of our team to provide patient care

Clients who engage in such behavior may:

Be asked to leave the premises immediately

Be escorted off the premises

Have future services refused

Have their client-patient relationship with Shady Brook Animal Hospital terminated at the discretion of hospital management

Require involvement of appropriate authorities if necessary.

We appreciate your partnership in helping us maintain a positive environment where our team can focus on what matters most—providing exceptional care for your pets.
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Mutual Respect Policy Acknowledgement* This field is required.I have reviewed and understand SBAH's Mutual Respect Policy and acknowledge that all individuals on the premises are expected to treat one another with courtesy, professionalism, and respect. I understand that Shady Brook Animal Hospital maintains a zero-tolerance policy for abusive, threatening, harassing, or disruptive behavior and that violations of this policy may result in the refusal or termination of services, termination of the client-patient relationship, removal from the premises, and, when deemed necessary, involvement of appropriate authorities. I also understand that if I ever feel disrespected, uncomfortable, or have concerns regarding the conduct of a staff member or another individual on the premises, I am encouraged to speak with the Hospital Manager as soon as I feel comfortable doing so.
I have reviewed, understand, and acknowledge.
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Want To Earn "Best Client Ever" Status?Upload any previous medical records and vaccine history you have! It helps our team know exactly what your pet needs and keeps appointments running on time. *Bonus points if we don't have to play detective to track them down.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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Optional: Show Us That Cute Face!Feel free to upload your favorite photo of your pet so we can add it to their hospital chart. Not only does it help us quickly identify your pet, but let's be honest—we enjoy seeing their adorable face every time we open their account. This photo will only be used within your pet's medical record. Uploading a photo does not grant permission for Shady Brook Animal Hospital to use it on social media, marketing materials, or for any other purpose.
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Date
Date
Month
Day
Year
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Signature* This field is required.
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