BIG NEWS! Our ancillary boarding facility is now just north of the hospital (815 West 22nd Street). We can’t wait to see you!

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 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 have read and accept.

Signature *

Date *

Name

New Client Form

We proudly serve the pets Hastings, NE and beyond.

Contact

Location

Hours

Boarding Hours

Have a question?

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