New Patient/Client Information

WELCOME TO DRIPPING SPRINGS ANIMAL HOSPITAL

Thank you for giving us the opportunity to provide quality care for your pet(s).

Date*
Owner's Name*
Spouse/Other
Address*
Street Address City State / Province / Region ZIP / Postal Code
Home Phone*
Work Phone*
Cell Phone*
Email Address*
Employer's Name & Address
In case of EMERGENCY, please call*
at phone number*
How did you first hear of our hospital?
- Brochure
- Hospital Sign
- Facebook
- Google
- Yelp
- Individual
- Other
If Individual; someone we may thank?
Photo and Sharing Authorization: We love treating your pets and enjoy the time you allow us to spend with them. On occasion, we would like to capture these moments in photo/video. These photos may be emailed to you as an update on their status/progress, used on our website, or shared on social media sites such as Facebook. Do you authorize us to photograph/video your pet for these purposes?*
- Yes
- No
PAYMENT IS DUE IN FULL AT THE TIME SERVICES ARE RENDERED
I understand that if I do not pay this account as agreed, the account is subject to costs of collection, attorney fees, and including interest (any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum). Return check fee is $30.00 plus tax. I understand that the hospital staff will provide an estimate of current and anticipated charges any time I request one. I am requesting that veterinary care be provided for pets presented by me or my agents. I understand that I am financially responsible for all services provided.

To prevent the spread of infectious disease and parasites all in-patients, out-patients, boarders and grooming pets must be current on all vaccines and be free of parasites. I understand this to be the strict policy of the clinic and authorize the doctors to provide my pet or pets with vaccinations and parasite control as needed.
About Pet 1
Name*
Species (cat, dog, other)*
Breed*
Description (color)*
Age*
Date of Birth*
Sex*
Neutered or Spayed*
Diet (kind of pet food)*
Hours Spent Outside Each Day*
Microchip Number
Temperament: Has your pet ever bitten anyone?*
Any other temperament concerns? Please explain.
VACCINATION & LAB HISTORY
(Dates Last Given)
(Dog) DHLPPC
(Dog) Bordetella
(Dog) Rabies
(Dog) Heartworm Test
(Dog & Cat) Heartworm Prevention
(Dog & Cat) Stool Check
(Cat) FVRCP
(Cat) Leukemia
(Cat) Rabies
(Cat) Feline Leukemia Test
(Cat) Feline Aids Test
Name and phone # of previous Veterinarian or Hospital for vaccination/medical history on your pet(s):
About Pet 2
Name
Species (cat, dog, other)
Breed
Description (color)
Age
Date of Birth
Sex
Neutered or Spayed
Diet (kind of pet food)
Hours Spent Outside Each Day
Microchip Number
Temperament: Has your pet ever bitten anyone?
Any other temperament concerns? Please explain.
VACCINATION & LAB HISTORY
Dates Last Given
(Dog) DHLPPC
(Dog) Bordetella
(Dog) Rabies
(Dog & Cat) Heartworm Test
(Dog & Cat) Heartworm Prevention
(Dog & Cat) Stool Check
(Cat) FVRCP
(Cat) Leukemia
(Cat) Rabies
(Cat) Feline Leukemia Test
(Cat) Feline Aids Test
Name and phone # of previous veterinarian or hospital for vaccination/medical history on your pet(s):
Signature*
Date*

New Patient/Client Information

WELCOME TO DRIPPING SPRINGS ANIMAL HOSPITAL

PAYMENT IS DUE IN FULL AT THE TIME SERVICES ARE RENDERED

About Pet 1

VACCINATION & LAB HISTORY

About Pet 2

VACCINATION & LAB HISTORY