Star Meadow
Animal Clinic
1073
Revolutionizing Animal Care in the
Home Hours and Location Our Services Our Veterinarians Our Support Staff
The Essentials of Wellness Medicine A Picture Tour of Our Facility
New Patient
Information
Name:______________________Age:________Breed:_____________________
Sex:____________
Spayed/Neutered?__________Color:________________________
Which
type of food do you feed your pet?_____________________________________
Is
your pet on any medication or special diets?
___________________________________________________
Does
your pet have any known drug allergies? ____________________________
Does
your pet take heartworm and flea/tick medication on a monthly basis?
Yes______
No_____
Do
you know of any area on your pet where they do not like to be handled?
___________________________________________________
If
you are bringing in a puppy for the first time, where was the puppy acquired?_________________
If
you are a dog owner, do any of your dogs demonstrate aggressive behavior toward
other dogs or people? ___________________________________________________
Has
your pet visited any other veterinary hospitals recently?
____________________________________________________
Are
you interested in:
Dental
Services:____________ Flea & Tick Control:___________ Microchip:_________
Boarding:__________ Heartworm Prevention:__________
Behavioral:______________
Pet
Nutrition:___________ Obedience Training:________________
I
understand that all charges are to be paid in full at time services are
rendered, or at time of discharge, and that a deposit is required for inpatient
services. I understand that the hospital staff will provide an estimate of
current and anticipated charges for any hospitalizations. By signing below, I am requesting that
veterinary care be provided for pets presented by myself or my agents. I
understand that I am financially responsible for all services provided.
Signature:____________________________________________Date:________
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