Welcome to Hickory Veterinary Hospital. We are so happy to work with you and your pet to give you both the best experience with excellent patient care! As a new client we ask that you please fill out the below form before coming in for your appointment. For our new clients who fill this out ahead of time, we are offering $10 off your first exam!

Please Note: This is for New Clients Only, not new pets. If you are a current client looking for a money saving program, ask us about our referral program, where you and a friend can save!

If you have not done so already, please call to schedule an appointment 610-828-3054.

[[[["field60","equal_to","Other"]],[["show_fields","field12"]],"and"],[[["field63","equal_to","Other"]],[["show_fields","field65"]],"and"],[[["field66","equal_to","Yes"]],[["show_fields","field68"]],"and"],[[["field70","equal_to","Yes"]],[["show_fields","field69"]],"and"]]
1
Welcome to Hickory!
Your Name (First and Last)
Spouse/Other (First and Last)
Address Line 1
Address Line 2
City
State
Zip Code
Primary Telephone
Secondary Telephone
In case of emergency, please call...
How did you hear about us?
If you chose "other" please specify:
Let's talk about your pet!
Pet #1 Name
Pet #2 Nameyour full name
Pet #1 Species (cat, dog, other)
Pet #2 Species (cat, dog, other)your full name
Pet #1 Breed
Pet #2 Breedyour full name
Pet #1 Sex
Pet #2 Sex
Spayed/Neutered?
Pet #2 Spayed/Neutered?
Pet #1 Description (Color)
Pet #2 Descriptionyour full name
Pet #1 Age/ Birthday
Pet #2 Age/ Birthdayyour full name
Is your pet (either one)aggressive?
If yes, please explain (If you have multiple pets be specific about which one)
Has your pet ever bitten anyone?
Are we going to be your pet's primary veterinarian?
Has your pet been seen previously by another facility?
Referring Veterinarians Nameyour full name
Referral Veterinarian Numberyour full name
Fileupload
Click Here to Upload Your Pets Records
Do we have permission to post pictures on our social media pages?

To prevent the spread of infectious diseases and parasites hospitalized and boarded animals must be current on all vaccines and free of internal and external parasites. By writing your name below, you agree that in the event you cannot provide written proof of such vaccines, you authorize the doctor to provide vaccines and parasite control as needed for your pet.

Signatureyour full name
Dateyour full name
Previous
Next