New Client - Vet Near Me

Client Information

Name*

First Last

Spouse

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone*

Spouse Phone

Employer*

If necessary, may we contact you at work?*

Yes

Fax Number, if applicable

Email Address*

Providing us with your email address will allow us to communicate with you in the event that we cannot reach you by telephone. Also, you will be able to access your pet portal through our website! There, you will be able to access your pet’s health information, access our online pharmacy, request appointments, received reminders, and more!

How did you hear about us? Who/what may we thank for referring you?*

What is your preferred method of being contacted?*

Patient Information

Patient Name*

First Last

Species*

Breed*

Date of birth*

Sex*

Male

Female

Spayed

Neutered

Color*

Is your pet on heartworm prevention?*

Yes

What type/brand:*

Is your pet on flea prevention?*

Yes

What type/brand:*

Has your pet been tested for viruses?*

Yes

What was the test date and results?*

Are there any other pets in your household?*

Yes

How many and what species?*

Previous medical records can be obtained from:

Add another pet?

Yes

Patient Name*

First Last

Species*

Breed*

Date of birth*

Sex*

Male

Female

Spayed

Neutered

Color*

Is your pet on heartworm prevention?*

Yes

What type/brand:*

Is your pet on flea prevention?*

Yes

What type/brand:*

Has your pet been tested for viruses?*

Yes

What was the test date and results?*

Are there any other pets in your household?*

Yes

How many and what species?*

Previous medical records can be obtained from:

Owner’s Right to Privacy

Texas Veterinary Licensing Act prohibits the disclosure of your name, address and your pet’s health care records (including rabies and other vaccinations) to anyone, without your authorization.

Would you allow us to release immunization records to boarding kennels and grooming facilities?*

Yes

Would you allow us to release your name, address and phone number(s) to someone who has found your lost pet(s)?*

Yes

Do you grant Forest Crossing Animal Hospital permission to use photos/videos of your pet on social media and/or for promotional purposes?*

Yes

Do you have pet insurance? Ask us how we can help you submit your claims!*

Yes

Financial Policy

Thank you for choosing FOREST CROSSING ANIMAL HOSPITAL. Our primary mission is to deliver the best and most comprehensive veterinary care available for your pet. An important part of the mission is making the cost of optimal care as easy and manageable for our clients as possible by offering several payment options. FOREST CROSSING ANIMAL HOSPITAL requires payment in full at the end of your pet's examination and/or at the time of discharge.

Payment Options

Cash, Visa®, MasterCard®, American Express®or Discover Card®
Convenient Monthly Payment Options¹ from the CareCredit® Healthcare CreditCard
o Allow you to begin treatment today and pay over time
o Available for any treatment amount greater than $1000
o $1000 or more can utilize 6 months no interest
o $2000 or more can utilize 12 months no interest
o Can be used repeatedly - for your entire family - without having to reapply¹

Deposit & Billing

For some treatments or hospitalized care, a deposit may be required. Healthcare plans requiring comprehensive care of , will require a 50% deposit to begin your pet's treatment. We may offer in-house payment options on a case-by-case basis. We charge 24% interest on all outstanding account balances older than 90 days. If you have an account 120 days past due, FOREST CROSSING ANIMAL HOSPITAL may relinquish your balance owed to a collection agency

Additional Policy Information

A fee of $50 may be charged for clients who miss or cancel more than 5 appointments in a calendar year without 24 hours notice. For clients with pet insurance, we are happy to provide you with the necessary documentation to submit a claim to your insurance carrier.

If you have any questions, please do not hesitate to ask. We are here to provide the best veterinary care available for your pet.

By signing below, you agree to the foregoing terms of payment:

Financial Policy

Payment Options

Cash, Check, Visa®, MasterCard®, American Express®or Discover Card®
Convenient Monthly Payment Options¹ from the CareCredit® Healthcare CreditCard
o Allow you to begin treatment today and pay over time
o Available for any treatment amount greater than $1000
o $1000 or more can utilize 6 months no interest
o $2000 or more can utilize 12 months no interest
o Can be used repeatedly - for your entire family - without having to reapply¹

Deposit & Billing

Additional Policy Information

FOREST CROSSING ANIMAL HOSPITAL charges $35 for returned checks. A fee of $50 may be charged for
clients who miss or cancel more than 5 appointments in a calendar year without 24 hours notice. For clients
with pet insurance, we are happy to provide you with the necessary documentation to submit a claim to your
insurance carrier.

If you have any questions, please do not hesitate to ask. We are here to provide the best veterinary care
available for your pet.

Signature*

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Same Day Appointments Available

Same Day Appointments

New Client Form

Download and Print Form

New Client Form

Client Information

Patient Information

Owner’s Right to Privacy

Financial Policy

Payment Options

Deposit & Billing

Additional Policy Information