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 *

Website

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.

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Contact

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

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Location

2217 West 2nd Street
Hastings, NE 68901

Click here for directions.

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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)

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APPOINTMENT