Primary (default) client contact:

Name *

First

Last

Phone number *

Please Select

cell
home
work

Email Address *

Physical Address *

Address Line 1

Address Line 2

City

State

Zip Code

Secondary (emergency) client contact

Name *

First

Last

Phone number *

Please Circle (copy)

cell
home
work

Email Address *

Patient Information

Pet's Name *

Age/Date of Birth *

Breed (include colors) *

Sex *

Male
Neutered Male
Female
Spayed Female

Do you have a second pet? *

Yes
No

Pet's Name *

Breed (include colors) *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Do you have a third pet? *

Yes
No

Pet's Name *

Breed (include colors) *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Do you have a fourth pet? *

Yes
No

Pet's Name *

Breed (include colors) *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Do you have a fifth pet? *

Yes
No

Pet's Name *

Breed (include colors) *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Previous veterinary clinic/hospital information so that we can acquire medical records:

Name *

Phone number

Website

Email Address *

How did you hear about Highland Pointe Animal Hospital?

Whom may we thank?

Plaese specify

Our hospital loves meeting and helping pets! We celebrate this by sometimes posting photos of our patients when they come to see us on our website and/or Facebook page. Please initial whether you approve or do not approve of Highland Pointe Animal Hospital taking photos of your pet(s) for this purpose.

I approve
I do not approve

Boarding/hospitalization Policy:

To prevent the spread of infectious diseases and parasites, hospitalized, boarded or pets here for grooming must be current on all vaccines (including Bordetella every six months for dogs) and be free of internal and external parasites (fleas and ticks). One of our veterinarians must have examined your pet(s) being boarded or groomed at least annually. I authorize Highland Pointe Animal Hospital to provide vaccines, parasite control, and an annual exam when needed.
Pets are released only during regular business hours. If I neglect to pick up my pet within 10 days from the time the scheduled boarding or treatment is complete, Highland Pointe Animal Hospital may assume that the pet is abandoned and is hereby authorized to dispose of my pet as appropriate.
If one of our veterinarians feels that sedation is necessary to calm your pet in order to prevent injury and/or address significant anxiety, please be assured that we will provide necessary treatment at your expense.
If one of our veterinarians feels that tranquilizers or general anesthesia is necessary for treatment or handling of your pet, please be assured that we will provide necessary treatment at your expense.
If an emergency health situation develops involving your pet, please be assured that we will provide necessary treatment at your expense.
Highland Pointe Animal Hospital will not be held liable under any circumstances on account of the care, treatment or safekeeping of my pet except for their respective gross negligence. Disputes, other than collection of your receivables, will be resolved through binding arbitration following applicable Texas law.
Payment for all services rendered will be required when your pet is released.

Medication / Prescription Policy:

We require 24 hours notice for all medication/prescription requests.
All medications filled by our hospital are non-refundable once they leave the building. This includes medications filled prior to patient death or euthanasia.

Payment Policy:

Payment is required upon rendering of services. Your choice of payment methods are cash, credit card
(Visa, Master Card, Discover, American Express), or payment plan via Care Credit or Scratch Pay.

Deposits or prepayments may be required on surgical, trauma/emergency, and/or
hospitalization cases.
We do not bill/carry open accounts and hope that the above alternatives are convenient.

I have read, understand, and agree to the Highland Pointe Animal Hospital policies.

Owner signature

Date

Field #73 (copy)

I authorize Highland Pointe Animal Hospital to treat my pet(s).

Owner signature

Date

To best serve you: If any of your pets ever unexpectedly requires life-sustaining measures (CPR: cardiopulmonary resuscitation) in an effort to preserve life, we need to know as a default if you want us to pursue CPR or not. The estimated cost of standard CPR is $250.00–300.00.

CPR Authorization

Perform CPR
DNR (Do Not Resuscitate)

Owner signature

Date

New Client Form

New Client Form

Primary (default) client contact:

Secondary (emergency) client contact

Patient Information

Previous veterinary clinic/hospital information so that we can acquire medical records:

Boarding/hospitalization Policy:

Medication / Prescription Policy:

Payment Policy:

Ready for a visit?

Connect with Us

Contact Info

Location

Hours