Welcome To Our Practice

Thank you for choosing Hill Country Animal Hospital. Our primary mission is to deliver the best and most comprehensive veterinary care for your pet now and in the future. Please take a moment to share some important information.

You may also print this form and bring it with you on your visit. Print

Fields with an * are required.

Title *: Dr. Mr. Mrs. Ms. Miss

Owner Name *

Spouse/Other

Address *

City *

State *

Zip *

Primary Phone *

Secondary Phone

Alternate

E-Mail **E-Mail is used solely for reminders and alerts and will not be shared. **

Employer

Spouse's Employer

How did you select Hill Country Animal Hospital? *

Individual whom we may thank for referring you:

Website

Internet - select:

Google Yahoo Bing Yelp Other

Welcome Letter

Hospital Sign

Other, please specify:

 

LATE POLICY: Depending upon the nature of your appointment, if you arrive late, you may be asked to reschedule. Late and/or missed appointments may result in alternate scheduling and a "no-show" fee.

FINANCIAL RESPONSIBILTY: For your convenience we will prepare an itemized Health Care Plan (Please ask your doctor or nurse). This is important to you because all fees are due at the time services are rendered. There will be a $25.00 fee for any check returned.

PRIVACY POLICY: Upon request, we may release your pet's medical history and/or vaccine history to other veterinary clinics or boarding facilities. We will not release your personal information without your permission.

Please initial if you would like your phone number to be released to someone who finds your lost pet.

Will you grant permission to us to use photos of your pet on our Facebook or website? * Yes No

By entering your name below, you are agreeing to and will abide by the above stated policies.

Signature * Date *

About your pet *

Type Pet's Name DOB/Age Gender Breed/Color



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