Welcome to Scott County Animal Hospital!

Welcome to Scott County Animal Hospital!

The doctors and staff at Scott County Animal Hospital are looking forward to meeting you and your pet(s)! We are committed to keeping you happy and your pet healthy. To help us serve you better, the doctors would like you to take a few minutes to fill out this form to the best of your ability. Thank you!
Client Information
Your Name*

First NameLast Name
Spouse/Significant Other's Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Whose Phone #?*
Primary Phone *

Area CodePhone Number
Whose Phone #?
Secondary Phone

Area CodePhone Number
Whose Phone #?
Other Phone

Area CodePhone Number
Your Place of Employment
Spouse/Significant Other's Employment
Your E-mail Address*
Alternate E-mail Address
How did you find out about us?*
If Current Client - whom?
Pet's Information
Dog or Cat?*
Male or Female?*
Spayed or Neutered?*
Pet's Name:*
Date of Birth (or approximate age):*
Breed:*
Color:*
How long have you had your pet?
Do you have pet insurance?
Where did you get your pet?
(humane society, breeder, pet store, etc?)
What medication(s) and/or supplement(s) is your pet currently taking (if none, please write "none")?
Does your pet have any known allergies or previous health problems?
What brand(s) and amount(s) of food does your pet eat?
Who was your last veterinarian (if any)?
Biting, AggressionExercise intoleranceSkin/coat condition/odorExcessive barkingShedding, mattingMouth sensitivity/droolingOverweight or UnderweightBad BreathHousetraining/ litter box issuesItching/licking/scratchingOther
PAYMENT IS DUE AT TIME SERVICES ARE RENDERED

We accept all major credit cards, CareCredit, checks and cash.

(if you are unable to pay in full at time of service, please inform a staff member prior to your appointment)

By providing us with your wireless/cell phone number, you are hereby granting us, and our agents or independent contractors, your consent to receive calls on your wireless/cell phone number for billing and debt collection purposes.
By typing your full name in the following field, it is considered your electronic signature and you are agreeing to the above terms and conditions.*
Additional Pets?
If yes, see below prior to clicking the 'submit' button.
Additional Pet Information
Dog or Cat?*
Male or Female?*
Spayed or Neutered?*
Pet's Name:*
Breed:*
Color:*
Date of Birth (or approx age):*
How long have you had your pet?
Do you have pet insurance?
Where did you get your pet?
(humane society, breeder?)
What medications and supplements is your pet currently taking? (If none, please write none).
Does your pet have any known allergies/previous health problems?
What brand(s) and amount(s) of food does your pet eat?
Who was your last veterinarian (if any)?
Please attach any vaccine or medical history from previous veterinarian.

Browse Files

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Biting, AggressionExercise intoleranceSkin/coat condition/odorExcessive barkingShedding, mattingMouth sensitivity/droolingOverweight or UnderweightBad BreathHousetraining/ litter box issuesItching/licking/scratchingOther
Should be Empty:

Welcome to Scott County Animal Hospital!

Client Information

Pet's Information

Additional Pet Information