Please Note: We will be closing early at noon on Tuesday, December 24th and will be closed on Wednesday, December 25th in observance of Christmas!

New Client Form

Please complete the form below prior to your first appointment.

APPOINTMENT

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Spouse/Co-Owner Name

First

Last

Spouse/Co-Owner Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Place of Last Vaccinations

Please list any current medications.

I attest that I am over the age of 19 and the legal owner of the pet(s) listed above. I hereby authorize the veterinarians of Companion’s Choice Animal Hospital to examine, prescribe for, and/or treat my pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of the release and a deposit may be required to hospitalize my pet(s) and/or provide surgical treatment/care. I understand that as a new client, I will be required to place a $50 deposit on my account to schedule an anesthetic event. The deposit is nonrefundable if I cancel or reschedule the appointment within 24 hours of the event. If I show up on time to the scheduled event, the deposit will offset charges incurred. *

I have read and accept.

Signature *

Clear Signature

Date *

Website

New Client Form

We proudly serve the pets Hastings, NE and beyond.

Contact

Location

Hours

Boarding Hours

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