Option 1

Complete Online

Complete and submit the online form below.

Option 2

Print & Complete

Bring the completed form with you to our hospital.

Download Form

Option 3

Complete on Arrival

If you prefer, fill out the form when you get to our hospital.

New Patient Form

Owner Information

Owner First Name

Owner Last Name

Secondary Owner / Authorized Agent Name

Primary Phone

Mobile Phone

Work Phone

Address

City

State

Zip Code

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

Patient Information

Pet Name

Birth Date / Age

Species

Breed / Other Species

Color

Gender

Spayed or Neutered?

Name of Previous Veterinary Provider

Fee Policy

All fees are due at the time of service. If you have financial concerns or constraints, we kindly ask that you disclose that to us prior to any treatments being provided.

I understand

Photo Release

Caring Hands Veterinary Hospital may use such photographs of me and/or my pet(s) with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, web content, or social media sites.

I agree

I disagree

Prescription Policy

Caring Hands Veterinary Hospital does not process prescriptions through third-party pharmacies such as Chewy, 1-800-PetMeds, Amazon Pharmacy, or similar providers. We are happy to fill prescriptions directly through our hospital, based on medication availability, or have them shipped to your home through our trusted online pharmacy. If you prefer to use a third-party pharmacy, we can provide a written prescription for you to submit to the pharmacy of your choice. Written prescriptions must be picked up in person at our hospital. We are unable to email, fax, or mail written prescriptions.

I understand

No Show/Late Appointment Policy

After two (2) no-show appointments, a deposit equal to the exam fee will be required before scheduling future appointments. This deposit will be applied to the exam fee at the time of the visit, or forfeit if the appointment is not kept. I also understand that if I arrive more than 10 minutes late, my appointment may need to be rescheduled. The hospital will make every effort to accommodate late arrivals when possible, but accommodation cannot be guaranteed.

I understand

Surgical Scheduling and Deposits Policy

To reserve a surgical procedure at Caring Hands Veterinary Hospital, a $150 scheduling deposit is required at the time of booking. On the Friday prior to your pet's scheduled surgery, one of our Veterinary Surgical Technicians will contact you to complete a pre-surgical consultation. During this consultation, the technician will review the treatment plan, answer any questions, and collect a pre-surgical deposit equal to the low end of the estimated procedure cost. Both the $150 scheduling deposit and the pre-surgical deposit will be applied toward the final cost of the procedure on the day of surgery. If the surgery is canceled after the pre-surgical consultation has been completed, or if you do not arrive for the scheduled procedure, both deposits will be forfeited and are non-refundable.

I understand

Consent

I hereby authorize Caring Hands Veterinary Hospital to examine, prescribe for or treat the above described pet(s). I understand Caring Hands’ rabies policy and that all pets will be administered a rabies vaccine, unless a medical exception is granted by the veterinarian. I assume all responsibility for all charges incurred in the care of my animals. I also understand that these charges will be paid for at the time of release and that a deposit may be required for surgical treatments or hospitalization.

I agree

Spam Blocker

New Patient Form

Option 1

Complete Online

Option 2

Print & Complete

Option 3

Complete on Arrival

New Patient Form

Owner Information

Emergency Contact

Patient Information

Fee Policy

Photo Release

Prescription Policy

No Show/Late Appointment Policy

Surgical Scheduling and Deposits Policy

Consent

New Patients Welcome