New Client Form

Shoal Creek Animal Hospital & Lodge provides our form online so that you can fill it out in the comfort of your own home and at your convenience. You can easily complete and submit the form on our website, and it will come straight to us! This will make checking in at your next appointment an easy process.

Client and Contact

First and Last Name

Address*

Address Line 2

City*

State/Province/Region*

Zip/Postal Code*

Home Phone*

Cell Phone*

Email*

DOB*

Last 4 of SSN*

Employer*

Employer Phone*

Employer Address*

City*

State/Province/Region*

Zip/Postal Code*

Spouse Information

First and Last Name

Address

Address Line 2

City

State/Province/Region

Zip/Postal Code

Home Phone

Cell Phone

Email

DOB

Last 4 of SSN

Employer

Employer Phone

Employer Address

City

State/Province/Region

Zip/Postal Code

How did you become aware of our clinic?

Choose one:*

If other, please specify

Emergency Contact Person*

Home Phone*

Cell Phone*

Preferred Veterinarian*

Name of Previous Veterinarian*

Previous Veterinarian's Phone Number*

Pet Information

Pet 1

Pet 1 Name*

Sex:*

Species:*

Breed*

Color*

DOB*

Pet 2

Pet 2 Name

Sex:

Species:

Breed

Color

DOB

Pet 3

Pet 3 Name

Sex:

Species:

Breed

Color

DOB

I understand that all fees are due at time of service. We accept Cash, Checks, Debit, Visa, MasterCard, American Express, Discover, CareCredit, Apple Pay, Trupanion, and Trupanion Express. If you are in need of alternative payment arrangements please discuss that prior to completion of services.*
Yes, I understand the fee policy.

Agreement to Conditions

I hereby authorize the veterinarian to examine, prescribe for or treat the above described pet(s). I understand that all animals must be current on vaccinations and testing for boarding, grooming, daycare and hospital procedures. I assume all responsibility for all charges incurred in the care of my animals. I also understand that these charges will be paid for at the time of release and that a deposit may be required for surgical treatments or hospitalization.

Photo Release: I agree that Amity Woods Animal Hospital and Lodge may use such photographs of me and/or my pet(s) with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, web content, or social media sites.

I have read the above statement and by submitting this form, I understand and agree to the conditions above.*
Accept