New Client Registration Form

Primary (default) client contact

Name*

First Last

Address*

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

Phone Number*

Please specify if phone number is:

Cell
Home
Work

Email*

Enter Email Confirm Email

Secondary (emergency) client contact

Name*

First Last

Phone Number*

Please specify if phone number is:

Cell
Home
Work

Email*

Enter Email Confirm Email

Previous veterinary clinic/hospital name (if any)

Previous veterinary clinic/hospital phone number (if any)

Previous veterinary clinic/hospital website (if any)

Previous veterinary clinic/hospital email address (if any)

How did you find out about our practice?

If Other, please specify:

If Personal Referral, is there someone we can thank for this referral?

Pet Information

Pet's Name*

Species*

Breed (if known)

Color

Date of Birth or Age (if known)

Special Identification (tattoo, microchip, etc.)

Sex*

Add A Second Pet to Form

Up to four total pets may be added.

Yes
No

Second Pet's Information

Second Pet's Name*

Second Pet's Species*

Second Pet's Breed (if known)

Second Pet's Color

Second Pet's Date of Birth or Age (if known)

Second Pet's Special Identification (tattoo, microchip, etc.)

Second Pet's Sex*

Add A Third Pet to Form

Up to four total pets may be added.

Yes
No

Third Pet's Information

Third Pet's Name*

Third Pet's Species*

Third Pet's Breed (if known)

Third Pet's Color

Third Pet's Date of Birth or Age (if known)

Third Pet's Special Identification (tattoo, microchip, etc.)

Third Pet's Sex*

Add A Fourth Pet to Form

Up to four total pets may be added.

Yes
No

Fourth Pet's Information

Fourth Pet's Name*

Third Pet's Species*

Fourth Pet's Breed (if known)

Fourth Pet's Color

Fourth Pet's Date of Birth or Age (if known)

Fourth Pet's Special Identification (tattoo, microchip, etc.)

Fourth Pet's Sex*

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 choose 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

Policies

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.
• Because boarding can be a stressful experience for some pets, we occasionally find that a boarding pet becomes ill (especially with diarrhea and/or vomiting) or injures itself away from home. This is usually not a serious illness (although on very rare occasions death can result) but it may require medical attention. Should this occur, please be assured that we will provide necessary treatment at your expense.
• 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.

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.

Consent*

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

Consent*

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

To best serve you: If any of your pets ever unexpectedly requires that life-sustaining measures be pursued (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.*

Perform CPR
DNR (Do not resuscitate)

Primary (default) client contact

Secondary (emergency) client contact

Pet Information

Second Pet's Information

Third Pet's Information

Fourth Pet's Information

Policies

Request an Appointment Today!