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Owner's Information:
First Name*
Last Name *
Address*
City, State & Zipcode*
Home Phone/Cell Phone*
E-Mail Address
Social Security # *
(Required, unless full payment
is made BEFORE services rendered)
Driver’s License State & Number
(We will not accept checks without this provided)
Employers Name, Address & Work Phone
Spouse/Roommates Name & Phone Number
How did you become aware of our Hospital?
Personal Recommendation (Whom may we thank?)
In case of EMERGENCY, Please call
Name & telephone number of previous veterinary
Animal's Information:Name
Breed
Color
Sex; Spayed/Neutered?
Date of Birth/Approximate Age
If you have multiple pets, please list them here and try to
include as much information as you can. Including, Name,
Age/Date of Birth, Sex & Breed. Also, including any
vaccine history you may know
Spring Mills Veterinary Hospital
5078 Williamsport Pike, Suite N
Martinsburg, WV
25404
304-270-1063
Financial Information
PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED
Spring Mills Veterinary Hospital accepts Mastercard, Visa, Discover, American Express and CareCredit. We do not provide or participate in any payment plans.
I understand that I am financially responsible for all services provided. I understand that the hospital staff will provide an estimate of current and anticipated charges any time that I request one. I am requesting that veterinary care be provided for pets presented by me or my agents. Please be aware that there will be a $25 return check fee.
We will have this form printed out for you when you come in for your first visit with us.
Before your first visit, please gather any previous medical or vaccine information that you may have for your pet. We will need this information to get an accurate record of your pet's medical history and to create the best treatment plan for your pet.
When you visit the hospital, please bring your animal in a carrier or on a leash. This will prevent any incidents with other animals that may also be in the lobby.
When the receptionists have you checked in, they will then escort you and your pet to an exam room where the technician will ask you a series of questions regarding your visit. Weight, temperature and a quick exam of your animal may happen at this time as well.
When Dr. Smith examines your pet, she will take the time to listen and ask questions so she can understand your concerns. She will also perform a physical examination of your pet-checking eyes, ears, mouth and listening to their heart. She will also ask you about his/her habits and activities.
We are very excited about meeting you and your pet. We will always strive to provide the level of care that the both of you deserve! Should you have any questions or concerns, please don't hesitate to call or email.
Welcome to our Online New Client form, you can use this form to make your first visit with us a little faster. Once your form is submitted, our receptionists will have it printed out for you to review and sign when you arrive. If you have any questions please feel free to email us. Thank you and we look forward to seeing you!
YOUR DOG’S VACCINE /MEDICAL HISTORY:
RABIES
DHLP PARVO CORONA
BORDETELLA
FECAL (STOOL SAMPLE)
HEARTWORM TEST/PREVENTION?
YOUR CAT’S VACCINE HISTORY:
RABIES
FVR - CP
LEUKEMIA
LEUKEMIA TEST
FECAL (STOOL SAMPLE)
Any previous serious illnesses or surgeries? Any allergies to vaccinations or medications?
Any previous serious illnesses or surgeries? Any allergies to vaccinations or medications?
