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New Client Information Form
Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.
Please fill out ONLY if you have called and already booked an appointment, this is NOT an appointment request form. Let the receptionists know you have filled this out online when you check in for your appointment to expedite the check-in process!
The required sections have a red * asterisk.
Owner's Name
Name
*
First
Last
Co-owner's Name & Contact #
Name
First
Last
Phone
Address
Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Day-Time Phone
*
Evening Phone
Mobile Phone
Email
*
Enter Email
Confirm Email
How did you find out about our practice?
Clinic Location
Personal Referral
Internet Search / Website
Yellow Pages
Clinic Sign
Newspaper / Print Media
Other
If Other, please specify:
If Personal Referral, is there someone we can thank for this referral?
Please use this area to give us any other relevant information about yourself or your family
Pet Information
Pet's Name
*
Species
*
Dog
Cat
Rabbit
Ferret
Bird
Reptile
or if other species
Breed (if known)
Color
Date of Birth or Age (if known)
Special Identification (tattoo, microchip, etc.)
Sex
Neutered Male
Spayed Female
Male
Female
Unknown
Previous Veterinary Practice (if any)
Previous Veterinarian (if any)
Date of last vaccines (if known)
What vaccines were given at this time
Is your pet on any medication or supplement?
Yes
No
If Yes, please list the medication or supplement
What food does your pet eat?
does your pet have allergies or drug reactions?
Yes
No
If Yes, please list the allergies and reactions
Are there any current or past medical conditions of which we should be aware?
Yes
No
If Yes, please comment on the condition(s) and indicate if they are current or past conditions
Please use the following box to give us any other relevant information about your pet
Financial Policy: Our primary mission is to deliver the best and most comprehensive veterinary care available for your pet. An important part of the mission is making the cost of optimal care as easy and manageable for our clients as [possible by offering several payment options. healthcare plans requiring comprehensive care of more than $200.00 will require a 50% deposit to begin your pet's treatment. All Creatures requires payment in full at the end of your pet's examination and/or at the time of discharge. All Creatures charges a fee of $25.00 for any returned checks. By checking the box below you agree to the foregoing terms of payment.
*
I agree
I do not agree
Medical Records Release: In accordance with the Veterinary Practice Act regarding the confidentiality of patient records, "a written authorization or other form of waiver executed by the client or an appropriate court order subpoena" is required in order for All Creatures Animal Hospital to produce copies of your pet's medical records. From time to time it may become necessary to retrieve or release medical record pertaining to your pet's medical history. By checking the below box you allow us to both obtain medical records on your behalf an dispense them as needed to other parties.
*
I agree
I do not agree
Δ
New Clients
What to Expect
Online New Client Form
About Us
Team
Take A Tour
Patient Gallery
Services
Anesthesia and Patient Monitoring
Avian Medicine and Surgery
Emergency
Exotic Pet Medicine and Surgery
Health Screening Tests
Medical Services
Nutritional Counseling
Preventive Services
Surgical Services
Additional Services
Pet Health
How-To Videos
News
Educational Articles
Links
Contact
Online Pharmacy
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