New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 817-431-2526 for a faster response.

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New Client Form

Thank you for giving us the opportunity to care for your pet. We’ll be happy to answer any questions you have about your pet’s health. To ensure the best care possible, please take the time to fill in this form completely.

Existing Client

New Client

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone No *

Emergency No

Spouse or Co-Owner’s Name *

How did you first hear of us?

(Person’s Name, Sign, Internet, Yellow Pages, Other)

Pet Information

Name *

Birth Date *

Species *

Cat
Dog
Other

Breed *

Sex *

Neutered *

Date *

Date Last Vaccination

Last Rabies Vaccination

Where shots obtained

Any Long Term Problems

Current Medications, If any

List names and types of any other pets you own:

I hereby authorize the veterinarian to examine, prescribe for, or treat, the above described pet(s). I assume responsibility for all charges incurred in the care of the animal. I also understand that these charges will be paid in full at the time of release and that a deposit may be required for surgical treatment.

Signature of Owner or Agent *

Date *

Authorize

I authorize the release of my pet’s records for boarding and grooming purposes. _______ (please initial)

Phone

Thank you for choosing Alta Vista Animal Hospital! Existing clients do not need to fill out an additional new client form.

New Client Form

New Client Form

Pet Information

Ready for a visit?

Get in Touch !

Contact Info

Open Hours

Question

We’re here to help.