WARNING

You are using an outdated browser. Please upgrade your browser to improve your experience.

Close [x]

ALL NEW CLIENTS- To facilitate entering you and your pet (s) in our computer, please fill out ALL THE BLANKS.

DATE:___________________

OWNER'S NAME:___________________________ HOME PHONE:_____________

CELL PHONE:___________________________

CURRENT ADDRESS:_________________________CITY:_________ZIP:__________

YOUR DRIVER'S LICENSE #______________ SPOUSE, ETC DL#____________

YOUR DATE OF BIRTH:______________SPOUSE, ETC D.O.B:______________

E-MAIL ADDRESS:___________________________________________________

Name of other FAMILY MEMBERS or FRIENDS who may bring in your pet:

_____________________________________________________________________

IN CASE OF EMERGENCY:

EMPLOYER (YOURS):_______________________WORK PHONE:____________

EMPLOYER (SPOUSE, ETC):_________________WORK PHONE:_____________

How did you hear about our hospital:

1)Friend or family recommendation           Yes ___________No___________

    Please provide the Name so we can thank them!!__________________________

2)Drove by and saw Hospital Sign             Yes___________No___________

3)Saw the Hospital in the Yellow Pages     Yes___________No___________

4)Found the Hospital on our Web Site        Yes___________No___________

5)Found the Hospital on Search Engine     Yahoo_______ Google Plus________

                                                              City Search________  Other_______

6) Other_______________________________________________________________ 

How many pets (dogs, cats, etc) do you care for:     Dogs:________Cats:_______________Others___________

What is their current diet? Commercial diet____________ Table/People food:_______ Special diet:___________Treats/bones:_____________

Is your dog(s) on Heartworm Prevention? YES____ No____ If YES, what kind?

  Sentinel Spectrum:_______  Sentinel________ Heartgard_______ Revolution______ Trifexis______

  Other:_________________________________________________

Is your pet(s) on any medication? YES___ NO___ Please List:________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Any Drug/Medication Reactions or Allergies? Yes____ NO____  Please list_________________________________________________________________________

Is there any other important medical history we should be aware of?)_______________________________________________________________________

****WE DO NOT OFFER PAYMENT PLANS OR MONTHLY BILLING SERVICES. SERVICES MUST BE PAID FOR AT THE TIME THEY ARE RENDERED. WE ACCEPT CASH, CHECK, CREDIT CARD (MASTERCARD, VISA, DISCOVER, & AMERICAN EXPRESS), AND CARE CREDIT.****

Connect With Us!

New Clients Receive Free First Office Visit & Examination

    brown_pet_portal.jpg   

THIS ---->https://allentxvet.com/new-patient-center/online-forms/new-client-information.html

Office Hours

Day
Monday7:00 AM7:00 PM
Tuesday7:00 AM6:00 PM
Wednesday7:00 AM7:00 PM
Thursday7:00 AM6:00 PM
Friday7:00 AM7:00 PM
Saturday9:00 AM10:00 AM
Sundayclosedclosed
Day
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
7:00 AM 7:00 AM 7:00 AM 7:00 AM 7:00 AM 9:00 AM closed
7:00 PM 6:00 PM 7:00 PM 6:00 PM 7:00 PM 10:00 AM closed

Visit Our Online Store

 

Newsletter Sign Up