WELCOME FORM

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Thank you for giving us the opportunity to care for your pet! Our goal is to provide compassionate and thorough health care for your pet through education and advanced medical care. You and your pet are our highest priority. We value your devotion to their health and well-being.

Please note: We will ask that there is a form filled out for each patient listed on the account.
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Date* This field is required.
Date
Year
Month
Day
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Primary Owner* This field is required.
First Name
Last Name
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Authorized Secondary User/ OwnerPlease note: Both parties authorize financial and medical responsibility. This allows either party to communicate, authorize, and assume responsibility of payment and services rendered.
First Name
Last Name
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Primary Phone Number* This field is required.
Area Code
Phone Number
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Additional Phone Number
Area Code
Phone Number
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EmailNote: This is so you can receive copies of your pet’s lab work, report cards, reminders, and occasional informational emails
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code? or
Receiving the email may take a few minutes, thank you for your patience!
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Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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What is your preferred method of contact?* This field is required.
Phone Call
Email
Text
Mailing Address
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My previous records are at the following facility/ facilities: please enter hospital/s here .
I authorize Mills Animal Hospital to request previous records from any/ all of the above mentioned facilities: Please Initial .
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How did you hear about us?
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Pet name* This field is required.
Pets name
Breed
Male or female?
Spayed or neutered?
Approx. age or birthday
Medications taken by your pet
Color and description
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We love positive experiences!: We love to make each visit a positive experience. We would like to reward your pet with a tasty treat while being in the clinic. Is this okay?* This field is required.
Yes, please!
No, thank you.
No, thank you. My pet has known food allergies.
No, thank you. My pet has known GI sensitivities.
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I authorize Mills Animal Hospital to post pictures of my pet on social media or marketing material.* This field is required.Social Media Consent
I accept
I decline
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I authorize Mills Animal Hospital to send marketing material via email and text message.* This field is required.Text Marketing Consent
I accept
I decline
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ALL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. I authorize treatment of my pet by the staff and doctors of Mills Animal Hospital and confirm that I am at least 18 years of age. I acknowledge that Mills Animal Hospital does not accept checks as a form of payment. Mills Animal Hospital offers financing for advanced or routine procedures through Care Credit & Scratch Pay. Mills Animal Hospital does not offer in-house payment plans outside of this option.* This field is required.Please review and sign.
Clear
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Appointments & Scheduling- We recommend that all routine or non-emergency visits have an appointment, so that we may respect the valuable time of all of our clients. We will, of course, see urgent matters or emergencies as needed with associated fees. We also require deposits for all surgeries and multi-pet appointments. Your deposit will go toward the price of the procedure if your pet comes in for the appointment.* This field is required.Please review and sign.
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Wellness Visits- We believe in the benefits of regular preventative care, and follow the standards established by our national veterinary associations. We will make all recommendations that best suit the needs of your individual pet and lifestyle. Rabies vaccines are required by the state to be current at the time of the visit. If a doctor feels the risk outweighs the benefit at the time of the visit, they can make the decision to complete inoculation at a later date. * This field is required.Please review and sign.
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Emergency Care- We recognize that emergency situations do arise and we will do everything in our power to accommodate your needs. Please call before arrival so we can help your family seek treatment in the best way possible. Work in appointments and emergency visits will be accommodated for as our schedule allows. At times, we may refer you to an area emergency hospital. We are a full service veterinary hospital, however we do not have staffing after business hours and may be limited in our abilities to see multiple clients at once. In these case, we will refer you to a local emergency services facility. * This field is required.Please review and sign.
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Pet Insurance, we ask that you bring any paperwork that may need to be filled out by our staff to your appointment. Please initial
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