New Client Form - Complete Pet Care Animal Hospital.

Welcome to the Pet Care Family!

We are so excited to meet you and your furry family! Please complete this form before your first visit so we can provide the best care possible while you are with us.

Your Information

Which location will you be visiting?*

Name:*

Address*

Street Address City State Zip Code

Home Phone:*

Cell Phone:*

E-mail:*

Place of Employment:*

Spouse or Significant Other's Name:*

Spouse or Significant Other's Phone:

How did you hear about us?*

Pet Information

How many pets would you like to sign up?*

Pet Name:*

Pet Species:*

Other Species:

Breed:*

Color:*

Age:*

Date of Birth:*

Sex:*

Weight:*

Pet Name:

Pet Species:

Other Species:

Breed:

Color:

Age:

Date of Birth:

Sex:

Weight:

Pet Name:

Pet Species:

Other Species:

Breed:

Color:

Age:

Date of Birth:

Sex:

Weight:

Previous Veterinary Hospital:*

Previous Veterinary Office Number:*

Upload Patient Records

Drop files here or

Max. file size: 5 MB, Max. files: 5.

Previous medical records, etc.

Emergency Authorization

In the event a medical emergency occurs while my pet is at Complete Pet Care Animal Hospital for any services, I give my permission to Complete Pet Care to provide emergency services if necessary. If yes, CPCAH will contact me immediately to update me. If no, I understand I may be compromising my pet's health.*

Yes

No

Initial:*

CPCAH Acknowledgements

1. Vaccine & Parasite Policy: To prevent the spread of diseases, all hospitalized, grooming/bathing, daycare, and boarding patients must be current on all Rabies, Distemper, and Bordetella vaccinations and free from internal and external parasites, including an annual fecal screening. I understand that these treatments, including the administration of a Capstar if fleas are found on my pet, will be administered to my pet if they are not currently up-to-date on these requirements and I am responsible for the additional charges.

2. Payment Responsibility: I understand that payment is my responsibility and is required before my pet is discharged from CPCAH. A written estimate for services and treatments plans can be provided to me if I request so from the hospital staff. Cash, in-state personal checks with a state drivers license, Visa, MasterCard, Discover, and American Express payments are all accepted. Complete Pet Care reserves the right to adjust service fees without notice.

3. After-hours notice: Complete Pet Care Animal Hospital is not a 24/7 facility. I understand that there will not be staff at the hospital overnight while my pet is boarding and/or hospitalized overnight. Complete Pet Care does provide an on-call doctor 24/7: however, I understand that they may not be able to properly treat my pet in the event of an emergency due to after-hours staffing and they may instead refer me to an emergency facility.

4. Doggie Daycare: If I am enrolling my dog in daycare, I agree to Complete Pet Care Animal Hospital's daycare policies:

a. My dog must be spayed/neutered if over the age of 6 months

b. Complete Pet Care Animal Hospital reserves the right to remove my pet from daycare if necessary to protect the health and well-being of my pet, the other dogs, and/or our staff

c. My pet will be interacting with other dogs indoors and outdoors, and there is a risk of injury for my pet. I will not hold Complete Pet Care Animal Hospital liable for any injuries or illnesses should they occur

d. If an approved individual other than myself will be picking up my pet, they will be responsible for payment at pick-up if I do not make arrangements at drop off

e. If I am unable to pick up my pet before business hours end, Complete Pet Care will happily make overnight accommodations and I will be responsible for any additional costs

Date:*

Signature:*

Welcome!

1. We’re Here for You:

Complete Pet Care is committed to your pet’s health, 24/7. Our on-call doctors are available to you day and night, giving you peace of mind that your pet will always have the best care possible

2. Personalized Pet Plans:

They say an ounce of prevention is worth a pound of cure, and Complete Pet Care agrees! We offer custom Preventative Health Plans to make sure your furry best friend gets all of their annually recommended preventative screenings, vaccines, and exams. In addition to giving your pet the best care possible, our plans provide an average savings of $100-300 a year!

View Preventative Health Plans

3. Convenient Patient Portal:

Sign-up with our online patient portal for access to appointment scheduling, medication refills, and more! Click on the link for your designated hospital to gain access to these great features.

Heritage Patient Portal Falls Pointe Patient Portal

Comments

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Complete Pet Care

Welcome to the Pet Care Family!

Your Information

Pet Information

Emergency Authorization

CPCAH Acknowledgements

Welcome!

1. We’re Here for You:

2. Personalized Pet Plans:

3. Convenient Patient Portal:

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