New Patient Form

    Name

    Phone

    Email

    Address

    City

    State

    Zip

    Microchip Number

    Pet's Name

    Age (DOB)

    CanineFeline

    Breed

    MaleFemale

    SpayedNeutered

    Is your pet aggressive? YesNo

    Color

    Approximate Weight (lbs)

    What is the main health concern you have about your pet?

    How did you hear about us?

    Do you have a regular veterinarian? If so, please list their name of clinic name and contact information

    I authorize Dr. Laura McMahan to examine, prescribe for, and treat the above pet. I assume responsibility for all charges incurred in the care of my pet listed above. I also understand that all professional fees are due at the time services are rendered.

    Are you ok with HousePaws sharing images or events on our social media page/website? YesNo

    Would you like to subscribe to our newsletter?

    $150.00 deposit is required for scheduled appointments and will be credited toward services provided. The deposit is non-refundable with less than 48 hr. (defined as 2 business days) notice of cancellation.

    Signature of responsible party: (Please sign below.)

    The information on this form is confidential and is to be used only by this veterinarian to provide care for your pet.