New Client Form

New Client and Pet Information Form

Welcome to Hillcrest Veterinary Clinic! We're so excited to welcome you to our family. Please fill out this form and send it back to us at least 24 hours before your appointment so we can have everything ready for you. 😊 Please only submit this form after you've contacted us to schedule your first visit! This form cannot be used to schedule an appointment.
Full Name*

First NameLast Name
Date of Scheduled Appointment*

MonthDayYear
Date
Hour MinutesAM/PM Option
We are currently offering our clients the option of coming inside for their exam or remaining curbside. If you do opt to come inside, please keep in mind that appropriately worn face masks are required regardless of vaccine status.
Due to the current COVID-19 situation, as of December 2nd, 2021 we are reinstating our curbside protocol for all appointments. Please select "I understand" from the dropdown menu as acknowledgement of this protocol. If you have any questions, or need to reschedule your appointment, please call 304-292-6933. As of this time, we are unsure when this protocol will be lifted.
Phone Number*
ex: 304-555-5555
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Spouse/Co-Owner

First NameLast Name
Spouse/Co-Owner Phone Number
ex: 304-555-5555
Spouse/Co-Owner Phone Number
Pet's Name*
Pet Species*
Please Choose One
Pet Breed*
i.e. German Shepherd, Husky, DSH (shorthaired cat), DLH (longhaired cat), Persian, etc.
Color/Markings*
i.e. Black/White, Brindle, Tri-Color, Tabby, etc.
Birth Date*

MonthDayYear
Sex/Altered*
Please Choose One
Purpose of Visit*
Please Choose One
We require medical records (if any are available) to be sent to us before your appointment date. Have you emailed your pet's medical history/vaccination history to us?*

Yes, I have emailed itNo, I have not but I will!My pet has no previous medical history
Our email address is reception@hillcrestveterinaryclinic.com
Do you have your pet's medical records/vaccination history with you today?*
Is your pet currently on flea, tick, and/or heartworm and intestinal parasite prevention?*

NexgardNexgard PLUSNexgard COMBOHeartgard PLUSInterceptor PLUSSimparica TRIORevolution PLUSBravectoAdvantage IIAdvantix IIAdvantage MultiFrontlineSeresto CollarOther (Please type below)
Other
Is your pet currently on flea, tick, and/or heartworm and intestinal parasite prevention?*
Is your pet currently on any other medications or supplements?*

Cosequin, Dasuquin, Glycoflex, or another joint supplementForti-Flora, Mycequin, or other ProbioticsPsyllium husk powder, Metamucil, or another fiber supplementNoneOther (Please type below)
Other
Is your pet allergic to any medications, vaccines, or foods?*

YesNoUnsure
If yes, please list below
Is your pet allergic to any medications, vaccines, or foods?*
Please note: We take pride in the quality of service and medical care you trust us with providing you and your pet. In an effort to maintain these standards, and to keep your costs down, we do not bill for services rendered. Payment is due at the time of service.

We accept cash, check, Care Credit, Scratchpay, VISA, MasterCard, Discover, and American Express.

By signing this form, you acknowledge that the information provided is accurate to the best of your knowledge, and that you agree to pay for professional services and medications as they are rendered. You may ask us for a copy of our financial policy or for an estimate of expected services at any time.
Please arrive to your appointment at your scheduled time. Due to our current scheduling restrictions, if you are more than 10 minutes late we will need to reschedule your appointment.

To ensure we are able to provide accurate and prompt care for your pet, please make sure we receive your pet's previous veterinary/medical records at least 24 hours before your appointment so our doctor can review them. If we do not receive records before your appointment time, we do reserve the right to reschedule your appointment. (This does not apply if your pet has never been seen by a veterinarian or has no medical history.)

Failure to reschedule or cancel your appointment at least 48 hours before your scheduled appointment time will result in the forfeiture of your deposit, and a new deposit will be required before you can schedule a new appointment.
I hereby certify that the information on this form is true and accurate. I acknowledge the payment and scheduling policies set forth in the above paragraphs.*
Today's Date*
The following questions are part of our ongoing mission to provide a Fear Free experience for all of our patients. Please answer as accurately as you can so that we can be prepared to provide the best experience for you and your pet.

Please visit Fear Free Pets to learn about Fear Free protocol and what that means for you and your pet. If you have any questions, please call us at 304-292-6933, email us at reception@hillcrestveterinaryclinic.com , or send a chat via our Hillcrest VC App (Android/iPhone). We're always happy to help!
Does your pet mind being around other animals?*

Yes!NoUnsure
Has your pet been prescribed anxiety or sedative medication in the past?*

GabapentinTrazodoneTramadolFluoxetine (Prozac)AcepromazineAlprazolam (Xanax)ClonidineLorazepamOther (Please type below)
Other
Have you tried any complimentary or alternative pharmaceuticals?*

Pheromone Therapy (Adaptil, Feliway)Calming Treats (Composure, Solliquin, etc)CBD OilThundershirtsOther (Please type below)
Other
Has your pet been prescribed anxiety or sedative medication in the past?
When your pet goes to the vet, they are...*

Eager/ExcitedCalm/HappySubdued/ReluctantFearfulAggressiveNot sure- we haven't been to the vet before!Other (Please type below)
Other
What kinds of treats does your pet like?*

Chicken Jerky (Canine)Peanut Butter (Canine)Liver Flavored 'Kong' Paste (Canine)Spray Cheese (Canine)Tempations (Feline)Churu Paste (Feline)I'll bring my own 😊They won't eat away from home! 🤷🏽Other (Please type below)
Other
Does your pet have any other preferences or issues we should be aware of? ie prefers men or women, vision/hearing impaired, leash reactive, etc. If none, please type N/A.*
Thank you so much!
Should be Empty:

New Client and Pet Information Form