Please complete your New Client Form prior to your first appointment. We look forward to meeting you soon!Owner's Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneDriver's LicenseWhich number is best to reach you?*HomeCellCan you receive text messages?*YesNoEmail* Add a Co-Owner?*YesNoName First Last Home PhoneCell PhonePet Health HistoryPet's Name*Sex*MaleFemaleNeutered/Spayed?*YesNoBreed*Color*Birthdate or Age*Current MedicationsPlease bring and give any medical records/vaccine records to the receptionists to make copies.Diet And EnvironmentWhat food does patient currently eat?*Amount & Frequency?*Is your pet on any dietary supplements?*YesNoDoes your pet consume table food?*YesNoIs your pet primarily indoor or outdoor?*YesNoAre there any other animals in the household?*YesNoDo you have your pet groomed or boarded outside of your home?*YesNoDo you travel outside of Texas with your pet?*YesNoPast HistoryHas your pet had any prior illnesses, accidents, or surgeries*YesNoIs your pet aggressive or fearful around strangers?*YesNoIs your pet on heartworm, flea/tick preventatives?*YesNoPlease list any other medications or supplements your pet receives.Does your pet have any known allergies to any medications?*YesNoHas your pet ever had a reaction to any vaccines?*YesNo To allow for ample time with all patients and surgical procedures, Hub City Vet Clinic operates by appointment only. We request clients be on time for their scheduled appointments and procedures. If you are 15 minutes late to your appointment, you may be asked to reschedule your appointment. Upon receipt of this request, our receptionist will reach out to you with the first available appointment time that coincides with your preferences. If we are unable to reach you or do not hear back from you within 24 hours, we will be unable to reserve your spot on the schedule. If you need to cancel an appointment, we ask you give a minimum of a 24-hour notice. This will allow us to better accommodate those individuals seeking immediate care. We strive to accommodate all emergency situations and unforeseen circumstances; however, please know these situations may be subject to additional fees. We ask that in any emergency, you CALL to advise our staff of your arrival, so that we may prepare accordingly. DO NOT submit an appointment request for an emergency. For your convenience, we offer limited same day appointments for urgent care and sick patients, but they fill up fast, so we recommend calling first thing in the morning.I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal.* I have read and agreeDo we have your permission to share your pet’s image and story on our social media, website, and other forms of related media?*YesNoWill you be using pet insurance?*YesNoI authorize my emergency contact (other than myself) to pursue treatment if I am unavailable. Your emergency contact must be an adult over the age of 18.* I have read and agreeEmergency Contact* First Last Emergency Contact Phone*Signature*Date* Date Format: MM slash DD slash YYYY CAPTCHA
