New Client Registration

At Springboro Veterinary Hospital and Urgent Care, your furry family member is in good hands. Thank you for choosing us to care for your furry family member!
Please complete the form below before your visit.

Emergency Contact Name*

Emergency Contact Phone*

How did you first hear of our hospital?*

Family/Friend

New Neighbor Letter

Drive By (Sign)

Referring Vet

Website

Google

Yahoo

Homeland K-9

Facebook

We consider our pets:*

Part of our family

Just pets

We want your pet to be social media famous, but we need your permission first: I grant permission to Springboro Veterinary Hospital, its employees, and authorized representatives to take photographs and/or video of me and/or my pet(s), to copyright, use, and publish same in print and/or electronically. Springboro Veterinary Hospital may also use and publish my pet’s story, including relevant medical history. I agree that Springboro Veterinary Hospital may use such photographs, videos, or stories, including me and/or my pet with or without our names and for any lawful purpose, including, for example, such purposes as social media, publicity, advertising, and other web content.*

Yes, I consent

No, I do not consent

PET HEALTH HISTORY

Pet's Name*

Sex*

Male

Female

Neutered/Spayed?*

Yes

Breed*

Color*

Birthdate or age*

Current Medications

Please bring and give any medical records/vaccine records to the receptionists to make copies

DIET AND ENVIRONMENT

What food does patient currently eat?*

Amount & Frequency?*

Is your pet on any dietary supplements?*

Yes

Does your pet consume table food?*

Yes

Is your pet primarily indoor or outdoor?*

Indoor

Outdoor

Are there any other animals in the household?*

Yes

Do you have your pet groomed or boarded outside of your home?*

Yes

Do you travel outside of Ohio with your pet?*

Yes

PAST HISTORY

Has your pet had any prior illnesses, accidents, or surgeries*

Yes

Is your pet aggressive or fearful around strangers?*

Yes

Is your pet on heartworm, flea/tick preventatives?*

Yes

Please list any other medications or supplements your pet receives.

Does your pet have any known allergies to any medications?*

Yes

Has your pet ever had a reaction to any vaccines?*

Yes

OFFICE POLICIES

To allow for ample time for all patients and surgical procedures, Springboro Veterinary Hospital and Urgent Care operates primarily by appointment. We request all our clients be on time for scheduled appointments and procedures. If you are 15 minutes late to your appointment you may be asked to reschedule your appointment. We do take Emergencies; however, these services may be subject to a higher fee schedule. For your convenience, we offer limited same day appointments for urgent care sick patients they fill up fast, so we recommend calling first thing in the morning. For your protection, and that of others, pets should be properly restrained by a leash or carrier upon arrival. If your pet requires special accommodations, please give us a call when you arrive so we can assist you and your pet. If you must cancel an appointment, we ask for 24 hours’ notice. For surgical appointments we ask for 48-hour cancellation notice. We accept cash, debit, or all credit cards. We also offer Care Credit or Scratch Pay financing to help make the highest quality care accessible to all our patients. We would be more than happy to fill your prescriptions or have your food orders ready for pick-up. Please call ahead or use our website to process refills. Please allow 24-48 hours for prescription refills, special order or controlled substances may require longer. We do not authorize online pharmacy requests by phone or fax, if you need a written prescription to be processed at the pharmacy of your choosing you will need to pick them up in person.

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. **

I have read and agree.

I understand that payment is ALWAYS DUE IN FULL at time of service. A deposit of 50% of the treatment plan may be required before treatments or hospitalization of your pet. I recognize that financial concerns should be discussed PRIOR to examination and treatment.*

I have read and agree.

I authorize my emergency contact (other than myself) to pursue treatment if I am unavailable. Your emergency contact must be an adult over the age of 18.*

I have read and agree.

New Client Registration

Emergency Contact Name*

Emergency Contact Phone*

How did you first hear of our hospital?*

We consider our pets:*

PET HEALTH HISTORY

Pet's Name*

Sex*

Neutered/Spayed?*

Breed*

Color*

Birthdate or age*

Current Medications

DIET AND ENVIRONMENT

What food does patient currently eat?*

Amount & Frequency?*

Is your pet on any dietary supplements?*

Does your pet consume table food?*

Is your pet primarily indoor or outdoor?*

Are there any other animals in the household?*

Do you have your pet groomed or boarded outside of your home?*

Do you travel outside of Ohio with your pet?*

PAST HISTORY

Has your pet had any prior illnesses, accidents, or surgeries*

Is your pet aggressive or fearful around strangers?*

Is your pet on heartworm, flea/tick preventatives?*

Please list any other medications or supplements your pet receives.

Does your pet have any known allergies to any medications?*

Has your pet ever had a reaction to any vaccines?*

OFFICE POLICIES

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. **

I understand that payment is ALWAYS DUE IN FULL at time of service. A deposit of 50% of the treatment plan may be required before treatments or hospitalization of your pet. I recognize that financial concerns should be discussed PRIOR to examination and treatment.*

I authorize my emergency contact (other than myself) to pursue treatment if I am unavailable. Your emergency contact must be an adult over the age of 18.*

Signature*

Date*