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(817) 421-5850
Always Open - 24/7
8830 Davis Blvd | Keller, TX
24/7 Vet Services
Emergency Pet Care
Pet Wellness
Pet Vaccinations
Spay/Neuter
Pet Teeth Cleaning
Parasite Prevention
Pet Surgery
Pet Euthanasia
Pet Medical Services
24/7 Emergency
Other Services
Boarding
The Barkstone
The Pet Lodge
Check On Your Pet
Dog Daycare
Cat & Dog Grooming
Our Vets
Current Clients
New Clients
24/7 Vet Services
Emergency Pet Care
Pet Wellness
Pet Vaccinations
Spay/Neuter
Pet Teeth Cleaning
Parasite Prevention
Pet Surgery
Pet Euthanasia
Pet Medical Services
24/7 Emergency
Other Services
Boarding
The Barkstone
The Pet Lodge
Check On Your Pet
Dog Daycare
Cat & Dog Grooming
Our Vets
Current Clients
New Clients
BOOK APPOINTMENT
New Client Info
New Client Info
Client Information
How did you hear about us?
Friend
Website
Direct Mail
Internet Search
Sign
Print Advertising
Other
Please enter the name of you friend.
Please tell us how you heard about us.
First Name
*
Last Name
*
Spouse Name
Address
*
City
*
State
*
Zip Code
*
Email
*
Phone
*
Spouse Phone
Alternate Emergency Contact Name
Alternate Emergency Contact Phone
Pet Information
Number of Pets
*
1
2
3
4
Pet 1
Name
*
Dog/Cat
*
Dog
Cat
Breed
*
Color/Markings
*
Age or DOB
*
Male/Female
*
Male
Female
Spayed/Neutered?
*
Yes
No
Microchip #
Pet 2
Name
*
Dog/Cat
*
Dog
Cat
Breed
*
Color/Markings
*
Age or DOB
*
Male/Female
*
Male
Female
Spayed/Neutered?
*
Yes
No
Microchip #
Pet 3
Name
*
Dog/Cat
*
Dog
Cat
Breed
*
Color/Markings
*
Age or DOB
*
Male/Female
*
Male
Female
Spayed/Neutered?
*
Yes
No
Microchip #
Pet 4
Name
*
Dog/Cat
*
Dog
Cat
Breed
*
Color/Markings
*
Age or DOB
*
Male/Female
*
Male
Female
Spayed/Neutered?
*
Yes
No
Microchip #
Current Veterinarian
Do you currently have a family veterinarian?
*
Yes
No
Would you like us to contact a previous vet for records for your pet?
Yes
No
Previous Clinic Name
Current Clinic Name - We will update your family veterinarian regarding your visit today.
Acknowledgment and Signature
I understand that payment is expected at the time services are rendered. I hereby authorize the staff of Creekside Pet Care Center to render any treatment which is deemed necessary to the health of my pet(s) while in custody of the hospital. I understand that in the event of any unusual or emergency circumstances, the staff will make every attempt to contact me or my designated representatives before, if time permits, proceeding with the treatment. I understand that I will be financially responsible for all emergency procedures including the Estimate of Charges provided to me in person or over the telephone. I understand that a deposit is required for all pets admitted to the hospital. I understand that if my account is not kept in good standing, a fi nance fee of $25 will be added to the account and it will be forwarded to a third-party collections agency, which may affect my credit rating.
*
I have read and agree to the statement above.
Signature of Owner / Agent / Good Samaritan
*
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Date
*
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