New Client Info Comal Pet Hospital offers our new patient form online so you can complete them in the convenience of your own home or office. Simply fill out the form below, and we will receive your submission electronically. New Client Info Client Information First Name * Last Name * Address * City * State * Zip Code * Email * Phone * Were you referred by a family member or friend? Yes No Please enter the name of who referred you. Spouse or Co-Parent Name Spouse or Co-Parent Phone Spouse or Co-Parent Email Alternate Emergency Contact Name Alternate Emergency Contact Phone Pet Information Number of Pets * 1 2 3 4 Pet 1 Name * Dog/Cat * Dog Cat Breed * Color/Markings * Age or DOB * Male/Female * Male Female Unknown Spayed/Neutered? * Yes No Unknown Microchip # Pet 2 Name * Dog/Cat * Dog Cat Breed * Color/Markings * Age or DOB * Male/Female * Male Female Unknown Spayed/Neutered? * Yes No Unknown Microchip # Pet 3 Name * Dog/Cat * Dog Cat Breed * Color/Markings * Age or DOB * Male/Female * Male Female Unknown Spayed/Neutered? * Yes No Unknown Microchip # Pet 4 Name * Dog/Cat * Dog Cat Breed * Color/Markings * Age or DOB * Male/Female * Male Female Unknown Spayed/Neutered? * Yes No Unknown Microchip # Current Veterinarian Would you like us to contact a previous vet for records for your pet? Yes No Previous Clinic Name I understand that payment is expected at the time services are rendered. I hereby authorize the staff of Comal Pet Hospital to render any treatment which is deemed necessary to the health of my pet(s) while in custody of the hospital. I understand that in the event of any unusual or emergency circumstances, the staff will make every attempt to contact me or my designated representatives before, if time permits, proceeding with the treatment. I understand that I will be financially responsible for all emergency procedures including the Estimate of Charges provided to me in person or over the telephone. I understand that a deposit is required for all pets admitted to the hospital. I understand that if my account is not kept in good standing, a finance fee of $25 will be added to the account and it will be forwarded to a third-party collections agency, which may affect my credit rating. I understand that photos/videos may be taken of my pet for training or marketing purposes. * I have read and agree to the statement above. Signature of Owner / Agent / Good Samaritan * Clear Date * Captcha If you are human, leave this field blank. Submit
