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? *

Yes
No

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

We proudly serve the pets Hastings, NE and beyond.

Our mission is to provide competent, high-quality comprehensive small animal health veterinary care. We strive to provide great care for our patients, clients, each other, and our hospital.

w

Contact

Phone: 402-462-2234
Fax: 402-461-3623
Email: welovepetsccah@gmail.com



Location

2217 West 2nd Street
Hastings, NE 68901

Click here for directions.

}

Hours

Mon, Wed, Fri: 8 AM - 5 PM
Tues, Thurs: 8 AM - 7 PM
Sat: 8:30 AM - 12 PM
Sun: 5 PM - 5:30 PM (Boarding Pick-up/Drop-off Only)

Have a question?

Complete the form below and we'll be in touch with you shortly.

Book Your Next Appointment Online!

Use our online appointment request form to book your next appointment online in minutes.

APPOINTMENT