Client Registration

Name/Owner *

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Address *

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Best Contact Number *

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Second Contact Number

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Best way to reach owner *

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Spouse/Co-Owner

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Email Address *

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How did you hear about Springhurst Animal Hospital?

If other, please specify

If recommended, by whom?

Pet Health History

Pet's Name *

Species

Dog
Cat
Other

If other, please specify *

Breed *

Color *

Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Medical Conditions

Pet’s Current Medications

Describe Your Pet’s Diet

Do you have a second pet? *

Yes
No

Pet's Name *

Species

Dog
Cat
Other

If other, please specify *

Breed *

Color *

Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Medical Conditions

Pet’s Current Medications

Describe Your Pet’s Diet

Do you have a third pet? *

Yes
No

Pet's Name *

Species

Dog
Cat
Other

If other, please specify *

Breed *

Color *

Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Medical Conditions

Pet’s Current Medications

Describe Your Pet’s Diet

Springhurst Animal Hospital Policies

For the health and safety of all pets and staff at Springhurst Animal Hospital, the following vaccinations are required at the stated intervals. We require that your pet(s) be current on these vaccinations if your pet stays for treatment and/or surgery.

Dogs must be current on the following vaccinations:

Rabies: Required yearly or every 3 years
DHPP: Required yearly or every 3 years
Canine Influenza: Required yearly
Fecal: Required every 6 months
Bordetella: Required every 6 months
Heartworm Test: Recommended yearly

Cats must be current on the following vaccinations:

Rabies: Required yearly or every 3 years
FVRCP: Required yearly
Feline Leukemia: Required yearly [outdoor cat ONLY]

Ferrets must be current on the following vaccinations:

Rabies: Required yearly or every 3 years
Distemper: Required yearly

Vaccination history may be transferred from another clinic in writing, by email springhursthosp@bellsouth.net, or by fax [502-326-2995]. If another clinic does not have a current record of vaccinations, then Springhurst Animal Hospital can update your pet’s vaccinations according to the above schedule. These vaccination protocols are for animals over 4 months of age. For pets under 4 months of age, we can update them on their puppy or kitten vaccinations.

A driver's license and date a birth are required to dispense controlled medications and payments by check.

Authorization

I assume responsibility for all charges incurred in the care of my pet. I also understand that these charges will be paid at the time of release and a deposit may be required for surgical treatment.

Forms of Payment Accepted: Cash, Check, Visa, MasterCard and Discover

There is a returned check fee of $75.00.

I have read and agree with the above terms of service.

Date *

Printed Name *

Date of Birth *

Phone number, and date of birth are required for billing purposes; check writing, dispensing controlled drugs.

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