New Patient-Continuation Registration Form **PLEASE NOTE THAT THIS FORM SHOULD ONLY BE COMPLETED IF YOU ARE AN ESTABLISHED CLIENT AND YOU HAVE A NEW PET COMING TO SEE US OR IF YOU ARE A NEW CLIENT THAT IS REGISTERING MULTIPLE PETS.**First Name* Last Name* Pet Name.* Breed* Sex* Male Male Neutered Female Female Neutered Color* Birthday or Age* Lifestyle*Indoor SolitaryIndoor SocialIndoor/OutdoorOutdoor OnlyDoes your pet have a history of fear, anxiety, aggression, or biting?* Yes No Do you have proof of vaccines and/or medical records? If your pet has previously been seen at another veterinary facility please have the records faxed to 210-697-8337What is the name of your previous vet. And what is their phone number (in case we need to call to get records). Reason for visit?* Pet's food is* Pet's current medication(s)? (Type NONE if not applicable)* Do you authorize us to use your pets picture and/or story for social media purposes?* Yes No Do you authorize Babcock Hills to release your pet's medical records to any other veterinary facility (clinic, shelter groomer, breeder, or boarding facility)?* Yes No Please list any major medical diagnosis or conditions your pet has: (Type NONE if not applicable)* I hereby authorize the veterinarian to examine, prescribe for, and/or treat the above-described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that all charges must be paid at the time services are rendered and that a deposit may be required for any surgical, hospitalization treatment, or extended boarding. Digital Signature* Date* MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.
