Owner Name(Required)

First Last

Any authorized guardians:

Are you the legal owner(s) of the Animal(s)(Required)

Yes

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Primary Phone(Required)

Secondary Phone

Check here to sign up for text reminders.

Email – Your email can be used to view your pet's medical records, make appointments, refill prescriptions, and more!(Required)

Check here to receive reminders and receipts via email

Check here to consent to using your pet’s image on Irving Pet Hospital’s social media outlets

Date of Birth(Required)

How did you become aware of our clinic?(Required)

Please specify

Whom can we thank for your visit?(Required)

Pet Information

Pet name(Required)

Species(Required)

Dog

Cat

Other

Breed(Required)

Color markings(Required)

Date of birth or age(Required)

Sex(Required)

Male

Female

Spay or neutered?(Required)

Yes

Name of previous vet?(Required)

Would you like us to request medical records from previous caregiver?(Required)

Yes

If yes please provide contact information for us:

Add a second pet?(Required)

Yes

Pet name(Required)

Species(Required)

Dog

Cat

Other

Breed(Required)

Color markings(Required)

Date of birth or age(Required)

Sex(Required)

Male

Female

Spay or neutered?(Required)

Yes

Name of previous vet?(Required)

Would you like us to request medical records from previous caregiver?(Required)

Yes

If yes please provide contact information for us:

Add a third pet?(Required)

Yes

Pet name(Required)

Species(Required)

Dog

Cat

Other

Breed(Required)

Color markings(Required)

Date of birth or age(Required)

Sex(Required)

Male

Female

Spay or neutered?(Required)

Yes

Name of previous vet?(Required)

Would you like us to request medical records from previous caregiver?(Required)

Yes

If yes please provide contact information for us:

The undersigned hereby acknowledges that s/he is entering into an agreement with Irving Pet Hospital for veterinary services. As owner or authorized agent, I understand that the hospital shall obtain permission for treatment from the person presenting the patient and shall provide an estimate of costs. I also realize that in the event of unforeseen circumstance, emergency measures may have to be instituted before my permission can be obtained. Fees are due and payable at the time services are rendered. A deposit may be required prior to performing service. Any past due accounts will be charged a finance charge of 1.75% monthly which is an annual percentage of 21% as well as a billing charge of $2.50 per month. There will be a service charge of $25.00 on all returned checks. Any account requiring outside collection will be charged all applicable collection fees incurred by this hospital. I have read the above and hereby authorize the veterinarian to examine, prescribe for, or treat the above pet(s). I assume responsibility for all charges incurred in the care of the animal. I also understand that ALL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED.

Digital Signature(Required)

By signing this document you agree to accepting all financial responsibility for any and all treatments performed, and that you are at least 18 years of age or older.

Date(Required)

CAPTCHA

Pet Information

Our hospital building is closed to the public, but our safe and convenient curbside care is still available!