New Patient Form

Name(Required)

First Last

Spouse / Partner's Name

Address

Street Address Address Line 2 City State ZIP Code

Home Phone(Required)

Cell Phone(Required)

Work Phone

Spouse's Phone

Spouse's Work Phone

Email(Required)

Are there any other authorized persons to approve treatment for your pet(s) on your behalf?

How did you hear about us?(Required)

Patient Information

Pet's Name(Required)

Species(Required)

Dog

Cat

Sex(Required)

Breed(Required)

Color / Markings(Required)

Date of Birth / Age(Required)

Please bring your pet's current vaccine history and medical records to their appointment.

Financial Policy

Round Rock Animal Hospital requires payment in full at the end of your pet's examination and/or at the time of discharge. We accept cash, check (with a valid Texas ID), Visa, MasterCard, American Express, Discover or CareCredit. For new clients dropping off their pet and some treatments or hospitalized care, a deposit may be required. Healthcare plans requiring comprehensive care of $500 or more, will require a 1/2 deposit of the estimated amount to begin your pet's treatment.

Round Rock Animal Hospital charges $30 for returned checks. A fee of $20.00 is charged for clients who miss or cancel more than 1 appointment in a calendar year without 24 hours notice. For clients with pet insurance, we are happy to provide you with the necessary documentation to submit a claim to your insurance carrier. By typing your name below it serves as your electronic signature and you agree to the foregoing terms of payment.

Owner's Signature(Required)

15349

New Patient Form

Patient Information

Financial Policy

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