Online Client Forms

Whether you are visiting as a new client, have a surgery scheduled, or you’re boarding your pet with us, you can fill out the appropriate form online. Complete your form(s), click submit, and we’ll be ready to receive you!

New Client Form

Name *

Name

First

Last

Spouse's Name

First

Last

Address *

Address

City

State/Province

Zip/Postal

Email *

Phone *

Alternate Phone

Place of Employment

Date of Birth

How did you find us *

Do you have a valid Texas Driver's License? *

Yes

Personal Recommendation (Whom may we thank?)

Patient Information

Pet's Name *

Species *

Breed *

Date of Birth *

Color *

Male or Female *

Spayed or Neutered *

Where was your pet last seen or vaccinated?

Name of Clinic *

Clinic Phone Number *

Dog's Vaccination History *

Rabies

DHP Parvo

Bordetella

Fecal Analysis

Heartworm Test/Prevention

Lepto

Does Not Apply

Cat's Vaccination History *

Rabies

Distemper-Rhino Calici

Leukemia Test

Leukemia Vaccine

Fecal Analysis

Does Not Apply

Our Pet(s) is: *

Member of our family

Child's pet

Backyard pet

Any previous serious illness or surgeries? *

Any allergies to vaccinations or medications? *

Is your pet on any special diets of medications? *

Add another patient Remove a patient

At your request if we are contacted by another veterinarian, insurance company, boarding or grooming facility, do we have permission to release your information?

Yes

I understand I need to bring my driver's license upon my pet's first appointment for Spencer Animal Hospital to make a copy. *

I understand

Signature *

Clear

Date *

All fees are due at the time services are rendered. We accept: cash, Visa, Mastercard, Discover, American Express, and Care Credit. Should you not handle your account in a timely fashion a 6% finance charge will be incurred monthly and or a collection fee if applicable.

By providing my number and email, I agree to receive emails, text messages, and phone calls, which may be recorded unless I opt-out of such communications. I understand that my consent to be contacted is not a requirement to purchase any product or service and that I can opt out at any time. Message & data rates may apply. Message frequency varies. Subscriptions may be canceled by texting STOP, END, QUIT, CANCEL or UNSUBSCRIBE.

If you are human, leave this field blank.

Boarding Agreement

Client Information

Name *

Name

First

Last

Address *

Address

City

State/Province

Zip/Postal

Phone *

Alternate Phone

Email *

Emergency Contact

Emergency Name *

Emergency Name

First

Last

Emergency Phone *

Pet Information

Pet Name *

Breed *

Color *

Date of Birth

Gender *

Male

Female

Spayed or Neutered *

Yes

Drop-off Date *

Drop-off time *

Pick-up Date *

Pick-up time *

Type of Food *

Dry

Canned

Brought Food

Has your pet eaten today *

Yes

Feeding Schedule and Amount of food *

Please list any medications to be given while pet is boarded

IE: Drug, 30mg tablet, 2 times/day

What time does your pet take their medication?

Please check all services to be given

Examination

Vaccinations

Heartworm Check

Intestinal Parasite Check

Bath Only

Flea Treatment

Nail Trim

Express Anal Glands

Nail Grind

Please list the items being left

Please be specific with color, print, and type

Would you like us to text you pictures of your pet while they board with us? *

Yes

What phone number should we send the photos to? *

Spencer Animal Hospital, Inc., as is allowed by Texas law, is not equipped with an on-site fire suppression sprinkler system and does not employ on-site personnel outside of normal business hours. All animals boarded at the Facility will be left unattended during those times.

Disclaimer

If a tranquilizer is necessary for treatment or handling, I give my permission to Spencer Animal Hospital to administer such medications

All animals entering the hospital must be up to date on vaccinations or they will be administered upon entry at the owner's expense.

I also authorize Spencer Animal Hospital to do whatever is necessary should an emergency arise. Payment is required when pet(s) are released.

All animals will be checked upon arrival for Ticks & Fleas. If found, a flea treatment or tick product will be administered at the owner's expense. If tick treatment is required we will notify the owner of the cost.

Capstar for pet's under 25lbs is $7.36
Capstar for pet's over 25lbs is $11.72

Pets are released only during regular office hours.

By signing below, you agree to these terms.

Signature *

Clear

Date *

If you are human, leave this field blank.

Drop-Off Form

Name *

Name

First

Last

Email *

Phone *

Alternate Phone

Pet Name *

Breed *

Date of Birth *

Color *

Gender *

Male

Female

Spayed or Neutered *

Yes

Reason for Examining your pet today

If there is a problem, when did you first notice the problem?

What did it look like then?

How has your pet's appetite and water consumption been?

Is your pet on any medications? *

Yes

Type?

Has your pet been vomiting or having any diarrhea?

To effectively diagnose and treat many problems, radiographs, blood test, and other procedures may need to be done. We will notify you before undertaking these tasks as to their need and cost. In the event of a life-threatening condition, we will make every attempt to stabilize your pet and then notify you as soon as possible as to the extent of the problem. Please make sure you have a phone number where you can be reached.

Best number to reach you today *

Alternative number *

Signature *

Clear

Date *

If you are human, leave this field blank.

Surgery Consent Form

Client Information

Name *

Name

First

Last

Address *

Address

City

State/Province

Zip/Postal

Phone *

Alternate Phone

Email *

Patient Information

Pet's Name *

Species *

Breed *

Sex *

Color *

Date of Birth *

I am the owner or agent for the owner of the above described animal and have the authority to execute this consent.

I consent

I do hereby consent and authorize SPENCER ANIMAL HOSPITAL, Inc. its staff, and their assistants to administer vaccinations, medications, tests, surgical procedures, and/or treatments as listed below and as the Doctors deem necessary for the health, safety, or well being of the above animal while it is under their care and supervision. *

I consent

List of vaccinations, medications, tests, surgical procedures, and/or treatments

Your pet will be undergoing general anesthesia plus a surgical procedure today. In order to help us identify any underlying abnormalities your pet may have, we require running a pre-surgical blood profile. These blood tests will help us assess the health status of your pet more completely and determine if there are any additional precautions we need to take before surgery.

Your pet will have an intravenous catheter inserted and receive fluids during surgery to help maintain a healthy blood pressure, hydration status, and to allow for the quick administration of life saving drugs should any adverse event occur.

I would like my pet microchipped while under anesthesia (additional $42.00) *

Yes

All animals will be checked upon arrival for Ticks & Fleas, if found, a flea treatment or tick products will be administered at the owner's expense. If tick treatment is required we will notify the owner of the cost.
Capstar for pets under 25lbs is $7.36.
Capstar for pets over 25lbs is $11.72.

I understand that during the performance of the procedure(s) or operation(s), unforeseen conditions may be revealed that necessitate an extension of the procedure(s) or operation(s) or different procedure(s) or operation(s) than those set forth. Therefore, I hereby consent to and authorize the performance of such procedure(s) or operation(s) as necessary and desirable in the exercise of the veterinarian's professional judgement.

I have been advised as to the nature of the procedure(s) or operation(s) and the risks involved. I realize that results cannon be guaranteed.

Signature *

Clear

Best phone numbers to reach you today *

Alternative phone

If you are human, leave this field blank.

Canine Vaccination Form

Name *

Name

First

Last

Email *

Address *

Address

City

US States

Zip

Phone *

Alternate Phone

Pet's Name *

Male or Female *

Spayed or Neutered

Date of Birth *

Breed *

Color *

Are you an existing Client? *

Yes

(Please select the services/products you would like to receive)

PLEASE BRING PREVIOUS RABIES CERTIFICATE & VACCINE HISTORY

DOG /Canine Vaccines (if age appropriate)

Pkg A : Rabies, DHPP (Distemper, Hepatitis, Parvo, Parainfluenza)---$36.00

Pkg B : Rabies, DHPP, Bordetella---$54.00

Pkg C : Rabies, DHPP, Heartworm Check---$67.00

Pkg D : Rabies, DHPP, Bordetella, Leptospirosis---$69.00

Pkg E : Rabies, DHPP, Bordetella, Heartworm Check---$85.00

Pkg F : Rabies, DHPP, Bordetella, Leptospirosis, Heartworm Check---$90.00

Pkg G : Rabies, DHPP, Bordetella, Leptospirosis, Heartworm Check, Influenza---$134.00

Dog / Canine Vaccines & Tests

Rabies---$12.00

DHPP (Distemper, Hepatitis, Parvo, Parainfluenza)---$24.00

DHPPL (Distemper, Hepatitis, Parvo, Parainfluenza, Leptospirosis)---$29.00

Bordetella---$18.00

Leptospirosis---$20.00

Influenza---$44.00

Heartworm Check---$31.00

We accept CASH or CREDIT CARDS ONLY—NO CHECKS ACCEPTED!

Preventives for Heartworm & Fleas

In order to purchase Heartworm Medication a Heartworm Test is REQUIRED

6 month Proheart injection

1-25lbs---$49.00

26-50lbs---$61.00

51-75lbs---$69.00

76-100lbs---$79.00

12 month Proheart injection

1-25lbs---$93.00

26-50lbs---$116.00

51-75lbs---$131.00

76-100lbs---$150.00

Simparica Trio - Single Dose

2.8-5.5lbs---$34.20

5.6 – 11lbs---$37.46

11-22lbs---$38.08

22-44lbs---$41.23

44-88lbs---$42.42

88-132lbs---$43.01

Simparica Trio - 6 months

2.8-5.5lbs---$171.02

5.6 – 11lbs---$187.29

11-22lbs---$190.42

22-44lbs---$206.14

44-88lbs---$212.08

88-132lbs---$215.05

Heartgard - Single Dose

1-25lbs 6pack---$9.99

26-50lbs 6pack---$12.85

51-100lbs 6pack---$14.83

Heartgard - 6 months

1-25lbs 6pack---$49.95

26-50lbs 6pack---$64.26

51-100lbs 6pack---$74.17

Bravecto 3 month Oral Flea Medication

4.4-9.9lbs---$73.80

9.9-22lbs---$75.21

22-44lbs---$77.14

44-88lbs---$78.19

88-132lbs---$78.90

At your Request if contacted by another veterinarian, insurance company, boarding or grooming facility, do we have permission to release your records? *

Yes

By signing below, I hear by authorize Spencer Animal Hospital, Inc to vaccinate my pet.

Signature *

Clear

Date

Aceptamos EFECTIVO O TARJETAS DE CREDITO SOLAMENTE: ¡NO SE ACEPTAN Cheques!

If you are human, leave this field blank.

Formulario de vacunación canina

Nombre *

Nombre

Correo electrónico *

Dirección *

Dirección

Ciudad

Estado

Código postal

Teléfono #: 1ro *

Teléfono #: 2do *

Nombre de la mascota *

Sexo de la mascota *

Castrado/a

FDN/Edad *

Raza *

Color *

¿Es usted un cliente existente? *

(Seleccione los servicios/productos que desea recibir)

POR FAVOR TRAIGA EL CERTIFICADO DE RABIA ANTERIOR Y LA HISTORIAL DE LAS VACUNAS

Vacunas Caninas (si la edad apropiada)

Pkg A : Rabia, DHPP(Moquillo, Hepatitis, Parvo, Parainfluenza) ---$36.00

Pkg B : Rabia, DHPP, Bordetella ---$54.00

Pkg C : Rabia, DHPP, Chequeo de Gusanos de Corazón---$67.00

Pkg D : Rabia, DHPP, Bordetella, Leptospirosis ---$69.00

Pkg E : Rabia, DHPP, Bordetella, Chequeo de gusanos de corazón ---$85.00

Pkg F : Rabia, DHPP, Bordetella, Leptospirosis, Chequeo de Gusanos de corazón ---$90.00

Pkg G : Rabia, DHPP, Bordetella, Leptospirosis, Chequeo de gusanos de corazón , Influenza---$134.00

Vacunas Caninas & Pruebas

Rabia---$12.00

DHPP (Moquillo, Hepatitis, Parvo, Parainfluenza)---$24.00

DHPPL (Moquillo, Hepatitis, Parvo, Parainfluenza, Leptospirosis)---$29.00

Bordetella---$18.00

Leptospirosis---$20.00

Influenza---$44.00

Chequeo De Gusanos De Corazón---$31.00

We accept CASH or CREDIT CARDS ONLY—NO CHECKS ACCEPTED!

Preventives for Heartworm & Fleas

In order to purchase Heartworm Medication a Heartworm Test is REQUIRED

6 meses Proheart injection

1-25lbs---$49.00

26-50lbs---$61.00

51-75lbs---$69.00

76-100lbs---$79.00

12 meses Proheart injection

1-25lbs---$93.00

26-50lbs---$116.00

51-75lbs---$131.00

76-100lbs---$150.00

Simparica Trio - Dosis única

2.8-5.5lbs---$34.20

5.6 – 11lbs---$37.46

11-22lbs---$38.08

22-44lbs---$41.23

44-88lbs---$42.42

88-132lbs---$43.01

Simparica Trio - 6 Meses

2.8-5.5lbs---$171.02

5.6 – 11lbs---$187.29

11-22lbs---$190.42

22-44lbs---$206.14

44-88lbs---$212.08

88-132lbs---$215.05

Heartgard - Dosis única

1-25lbs 6pack---$9.99

26-50lbs 6pack---$12.85

51-100lbs 6pack---$14.83

Heartgard - 6 Meses

1-25lbs 6pack---$49.95

26-50lbs 6pack---$64.26

51-100lbs 6pack---$74.17

Bravecto Medicamento Oral de 3 Meses Para las Pulgas

4.4-9.9lbs---$73.80

9.9-22lbs---$75.21

22-44lbs---$77.14

44-88lbs---$78.19

88-132lbs---$78.90

A su solicitud si somos contactado por otro veterinario, compañía de seguros, guarderia o estilista, ¿tenemos permiso *

Al proporcionar mi número y correo electrónico, acepto recibir correos electrónicos, mensajes de texto y llamadas telefónicas, que pueden grabarse a menos que opte por no recibir dichas comunicaciones. Entiendo que mi consentimiento para que me contacten no es un requisito para comprar ningún producto o servicio y que puedo cancelar mi suscripción en cualquier momento. Se pueden aplicar tarifas de mensajes y datos. La frecuencia de los mensajes varía. Las suscripciones se pueden cancelar enviando un mensaje de texto con DETENER, FINALIZAR, SALIR, CANCELAR o cancelar suscripción.

Al firmar a continuación, Autorizo Spencer Animal Hospital, Inc para vacunar a mi mascota.

Firma del cliente *

Clear

Fecha

Aceptamos EFECTIVO O TARJETAS DE CREDITO SOLAMENTE: ¡NO SE ACEPTAN Cheques!

If you are human, leave this field blank.

Feline Vaccination Form

Name *

Name

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address

City

State/Province

Zip/Postal

Pet's Name *

Pet's Sex *

Spayed/Neutered *

Yes

DOB/Age *

Breed *

Color *

Are you an existing client? *

Yes

(Please select the services/products you would like to receive)

PLEASE BRING PREVIOUS RABIES CERTIFICATE & VACCINE HISTORY

Cat/Feline Vaccines (if age appropriate)

Pkg A: Rabies and FVRCP (Deline Distemper)---$36.00

Pkg B: Rabies (1 year), FVRCP (Feline Distemper) and Feline Leukemia---$53.00

Rabies (3 year IF APPLICABLE), FVRCP (Feline Distemper) Leukemia---$53.00

Cat/Feline Individual Vaccines

Rabies---$12.00

Leukemia---$38.00

FVRCP (Feline Distemper)---$24.00

FVRCP/Leuk Combo---$41.00

Revolution Plus - Cat - Single Dose

5.6-11lbs---$28.01

11.1-22lbs---$28.72

Revolution Plus - Cat - 6 months

5.6-11lbs---$140.06

11.1-22lbs---$143.58

At your Request if contacted by another veterinarian, insurance company, boarding or grooming facility, do we have permission to release your records? *

Yes

By signing below, I hear by authorize Spencer Animal Hospital, Inc to vaccinate my pet.

Signature *

Clear

Date *

If you are human, leave this field blank.

Formulario de vacunación felina

Nombre del cliente *

Nombre del cliente

Correo Electrónico *

Teléfono #: 1ro *

Teléfono #: 2do

Dirección *

Dirección

Ciudad

Estado

Código postal

Nombre de la mascota *

Sexo de la mascota *

Castrado/a? *

FDN/Edad *

Raza *

Color *

¿Es usted un cliente existente? *

(Seleccione los servicios/productos que desea recibir)

POR FAVOR TRAIGA EL CERTIFICADO DE RABIA ANTERIOR Y LA HISTORIAL DE LAS VACUNAS

Vacunas Gato/Felino (si es apropiado para la edad)

Pkg A: Purvax Rabia (1 año), FVRCP (Moquillo Felino)---$36.00

Pkg B: Purvax Rabia (1 año), FVRCP (Moquillo Felino) Leucemia---$53.00

Gato/Felino Vacunas & Pruebas

Purevax Rabia---$12.00

Purevax Leucemia---$38.00

FVRCP (Moquillo Felino)---$24.00

FVRCP (Moquillo Felino) + Leucemia---$41.00

REVOLUTION PLUS- Gato (Peso 5.6-11lbs)

Dosis única---$28.01

6 meses---$140.06

REVOLUTION PLUS- Gato (Peso 11.1-22lbs)

Dosis única---$28.72

6 Meses---$143.58

A su solicitud si somos contactado por otro veterinario, compañía de seguros, instalaciones de guarderia o estilista, ¿tenemos permiso para liberar sus registros? *

Al firmar a continuación, yo autorizo Spencer Animal Hospital, Inc para vacunar a mi mascota.

Firma del cliente *

Clear

Fecha *

¡Aceptamos EFECTIVO o TARJETAS DE CREDITO SOLAMENTE—NO SE ACEPTAN CHEQUES!

If you are human, leave this field blank.