New Patient-Continuation Registration Form | Babcock Hills Veterinary Hospital, P.C.

**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*
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 210-697-8337
Reason for visit?*
Pet's food is*
Pet's current medication(s)? (Type NONE if not applicable)*
Do you authorize Babcock Hills to release your pet's medical records to any other veterinary facility (clinic, shelter groomer, breeder, or boarding facility)?*
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*
Name
This field is for validation purposes and should be left unchanged.