Welcome to Sweetgrass Animal Hospital. Thank you for giving us the opportunity to care for your pet. We'll be happy to answer any questions you have about your pet's health. Please take this time to fill in this form completely.
Owner's Name:
Email:
Spouse Name:
Street Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Emergency Phone:
How Would You Like to Receive Your Yearly Reminders?:
Employer:
Work Phone:
Spouse Employer:
Spouse Work Phone:
How did you hear about our hospital?
Details about how you heard about us (from above)
Pet's Name
Species
Gender
Birth Date
Breed
Color
List Any Medications Your Pet is Currently Taking:
List Any Allergies Your Pet May Have:
Date of Last Vaccines:
Where Received:
Vaccination History: Please provide the name and number of the veterinary clinic for us to obtain your pet's history. If you have records please provide them as soon as possible to get your pet(s) up to date in the sysytem.
Current Veterinarian:
Phone:
I grant Sweetgrass Animal Hospital permission to post my pet's picture and/or story on their social media accounts.
Thank You for your commitment to your pet's health and welfare. Payment is required at the time of services rendered. A deposit may be required. Forms of payment accepted are credit card (Visa, MasterCard, and Discover), Cash, and Care Credit. If at any time you have questions regarding costs or charges, please do not hesitate to ask. I have read and understand the policies discussed above.
Guardian's Signature
Date