Client Information

This section is all about you.

Name *

Name

First Name

Last Name

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Daytime Phone *

Daytime Phone

(###)

###

####

Evening Phone *

Evening Phone

(###)

###

####

Email Address *

Pet Information

This section is all about your pet.

Name *

Name

First Name

Last Name

Age *

If you don't know the exact age of your pet, simply estimate.

Type *

Breed *

Gender *

Male

Female

Neutered/Spayed *

Neutered

Spayed

Unaltered

Vaccines *

Are your pet's vaccines current?

Yes

Medical Records *

Do you have medical records on this pet?

Yes

Other Veterinary Practices *

Do you have medical records from another veterinary practice?

Former Veterinary Practice

What is the name of the veterinary practice you used?

Record(s) Transfer

May we request a transfer of records?

Yes

Reason or conditions that prompted you to contact us: *

Special requests or conditions:

Additional Pets

If you have any other pets, please list them here. (name, age, type, and breed)

Would you like for us to call you to set up an appointment? *

Yes, I would like for Dogwood to call me to set up an appointment.

No, I have already set up an appointment to see a vet at Dogwood.

Please Read *

I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Dogwood Veterinary Hospital and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Dogwood Veterinary Hospital's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges. I have read this statement and

I agree

I disagree

Thank you for allowing Dogwood Veterinary Hospital to become part of you family. We look forward to working with you and meeting your pet.

You New Client information has been received and someone from our office will be contacting you soon. If for some reason, you don't hear from us within 2 business days, please give us a call at 573.335.6590 and let us know that you have filled out a New Client form via our website.

Welcome! We're thrilled you've decided to make Dogwood Veterinary Hospital a part of your family.

As a new client, you may expedite your check-in by completing the form below. Once your application has been processed, a member of our team will be in contact with you.

New Client Expedited Check-In