New Clients Welcome! Learn more about what we can do for your pet!

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New Client Form

New Clients Are Always Welcome

Please fill out our new client information form after you have scheduled an appointment with us. To schedule an appointment, please call 614-444-9696 or use our online scheduling platform.

"*" indicates required fields

Client Information

Thank you for giving us the opportunity to care for your pet. Please help US better meet your needs by taking a few moments to fill out the form below.

Primary Owner's First Name*

Primary Owner's Last Name*

Cellphone*

Do you authorize GVVH to text you?*

Yes

Email*

Secondary Owner's Name

Cellphone

Address*

Street Address

City

State

ZIP Code

Do you authorize GVVH to use any photos of you and/or your pet's taken during your visit with us on social media?*

Yes

How did you hear about us?*

Hospital Sign

Website

Internet

Social Media

Current Client Referral

Other

If a current client referred you, please write their name below so we can give you both a $25 credit on your account

Patient Information

You may skip this part if you have been a client with us for over a year.

Name

Species

Cat

Dog

DOB

MM slash DD slash YYYY

Breed

Color

Sex

Male

Female

Intact

Spayed/Neutered

What heartworm and/or Flea/Tick prevention is your pet on?

Is your pet microchipped?

Yes

Is your pet fearful at the vet?

Yes

Do you have pet insurance?

Yes

Upload pet records here

Max. file size: 50 MB.

Do you want to add a second pet to your account?*

Yes

Name

Species

Cat

Dog

DOB

MM slash DD slash YYYY

Breed

Color

Sex

Male

Female

intact

Spayed/Neutered

What heartworm and/or Flea/Tick prevention is your pet on?

Is your pet microchipped?

Yes

Is your pet fearful at the vet?

Yes

Do you have pet insurance?

Yes

Upload pet records here

Max. file size: 50 MB.

Authorization

Photo Release – I authorize German Village Veterinary Hospital to take photographs of my pet and to use and publish them in print and/or electronically. This could include purposes such as social media, website and newsletters. My name will not be used but my pet’s name may or may not be included.*

Yes

Records Release – I authorize the release of my pet’s medical records to another facility (boarding/daycare/emergency hospital, etc) should they be requested.*

Yes

Payment & Fee Schedule – We accept cash, credit/debit cards (Visa, Mastercard, Discover, Amex) and Care Credit. At your request, we will gladly discuss and/or prepare a written estimate of treatment costs. I understand that payment for all services rendered is due at time of service and that a deposit may be required for surgeries or hospitalization.*

I understand and agree to these terms.

Signature*

Date*

MM slash DD slash YYYY

This field is for validation purposes and should be left unchanged.