New Client Information

Thank you for giving us this opportunity to care for your pet. Please help us meet your needs better by completing this information sheet. Please note that all professional fees are due at the time services are rendered.

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CLIENT INFORMATION
Your Name (First and Last)
Spouse/Other (First and Last)
Address Line 1
Address Line 2
City, State, and Zip Code
Primary Telephone
Spouse/Other Cell Number
Who should we contact in case of emergency? (Name)
If you selected Other please specify:
ANIMAL MEDICAL HISTORY
Pets Name
If a Referral:
Veterinarian/Name
Telephone Number
Please check all that apply:
If you selected Other please specify:
Species (cat, dog, other)
Breed
Description (Color)
Age (Years)
If yes, please explain
If yes, please explain
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 checking this box, 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.
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Helping and healing for over 75 years.

Hickory Veterinary Hospital was founded in 1956 as a team of professionals committed to excellence in animal care. Our continued goal is to deliver the highest quality of veterinary medicine to our patients.