Happy Tails Animal Hospital

Happy Tails Animal Hospital

“Where your pet is family”

Welcome! Thank you for choosing Happy Tails Animal Hospital to care for your special family member.

Please complete both sides

Primary Contact

Name______

Address______Apt/Lot#______

City______State______Zip______

Primary Phone______Secondary Phone______

Email______Alt email______

Employer ______Employer Phone ______

Driver’s License# ______State ______

Joint/Secondary Contact

Name______

Address______Apt/Lot#______

City______State______Zip______

Primary Phone______Secondary Phone______

Email______Alt email______

Employer ______Employer Phone ______

Driver’s License# ______State ______

Would you like to be reminded of due dates? Phone ____ Email ____ Post Card ___

How did you hear about our clinic? Phone Book ___ Internet ___ Driving by ___ Other______

Your pet is considered A part of the family ___ Just a pet ______

Are you Civil Service______Military ______(please provided ID for discount)

I hereby DO ______DO NOT ______(Please initial) give Happy Tails Animal Hospital permission to use my pets images and/or video on social media and/or advertising purposes.

At your request, we will gladly discuss the cost of services and/or prepare a written estimate for recommended procedures

Professional fees are due at the time services are rendered. In some cases, a deposit may be required before services are rendered. If there are special circumstances, speak with us and we may able to offer some assistance in making sure your special family member is cared for.

We accept cash, checks drawn from a local bank, debit card, Visa, Mastercard, American Express, Discover and Care Credit.

*To prevent the spread of infectious diseases and parasites, we recommend that the animals be current on all vaccines

*Pets presented with fleas and/or ticks will be immediately treated with a topical or oral flea medication on admission and theprescription cost will be included on your invoice.

*Unless medically compromised, it is mandatory under the law that all dogs and cats over the age of 12 weeks be vaccinated for rabies. Otherwise, please provide proof of current vaccines or we will vaccinate on admission and the cost will be included in the invoice.

Failure to comply will result in the involvement of law enforcement

I acknowledge that upon signing this document, I have chosen and authorize Happy Tails Animal Hospital to provide services for my pet. I acknowledge that I am responsible for any and all cost incurred

Signature______Date______

Pet 1 Pet 2 Pet 3

Name
Species
Breed
Description
Date of Birth
Sex/ Spayed/Neutered
Length of ownership
How Obtained
Microchip #
Previous Vet(for history)
Diet
Current Medications
and dosage
Medical History
Prior Surgeries/dentistry

Is there is anything else that you would like us to know about your pet?

______