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Hours 1025 W. Hebron Pkwy #137
Carrollton, TX 75010

New Patient Registration Form

To ensure the best possible care, please fill out this form. Thank you for allowing us to care for your pet.

Spouse/Partner

Reson for Visit*

Pet Health History

Pet's Name*

Species*

Dog

Cat

DOB/Estimated Age*

Breed*

Color*

Sex*

Male Intact

Male Neutered

Female Intact

Female Spayed

Known Allergies

Authorization

I hereby authorize the veterinarian to examine, prescribe, and/or treat the above-described pet. I assume responsibility for any charges incurred for the treatment/care of my pet. I also understand that these charges are to be paid at the time of release and that a deposit or prepayment may be required for approved treatments.

I understand that failure to reschedule or cancel my appointment 24 hours in advance, by phone during regular business hours, will result in a $39.00 no-show or late cancel fee.

Same-day cancelation or rescheduling will incur a $39.00 fee. Payment is required before appointments can be scheduled. Accounts with NoShow/Late Cancel fees are on hold until payment is received.

After 1st free exam, I understand that a normal office visit will be $39.00 plus any additional services.
*

By checking this box, I am electronically signing my application.

IMPORTANT: ANIMAL BITES CAUSE SERIOUS INJURIES

For the safety of our staff, clients, children, and other pets, YOU MUST INFORM US NOW if your pet has ever bitten or shown signs of aggression or fear toward another animal or human.

If your pet has aggressive behavior, you must be able to safely place a muzzle on your pet. Without a muzzle, we will not be able to provide medical services.

We are required to report all bites to Animal Control and your pet will be quarantined at your expense.

Vetsavers Pet Hospital is a non-discriminatory, equal-opportunity environment. We do not tolerate discrimination based on race, color, gender, age, sexual orientation, or any other legally protected factor. In the event a client discriminates against any Vetsavers staff member, we must immediately terminate the veterinary patient/client relationship.

PLEASE INITIAL ACCEPT (NOT OPTIONAL):*

Vetsavers Pet Hospital