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New Client
Current Client with a New Pet Form
Current Client with a New Pet Paperwork
Please note that this form is intended for existing clients to add a new pet to their account. If you have never been to Bijou Animal Hospital before please use New Client Form.
*
Indicates required field
Owner's Name
*
First
Last
Phone Number
*
Email
*
Pets name
*
Species
*
Canine
Feline
Rabbit
Ferret
Rat
Mouse
Hamster
Guinea Pig
Other species
If you selected other species please describe
*
Breed
*
Gender
*
Unknown
Male
Female
Is this pet spayed/neutered?
*
Yes
No
Not Sure
Color
*
Birth date/Age
*
For birth date please use format mm/dd/yyyy. If listing age please specify if it is years, months, or days.
Microchip Number
*
Date of last vaccination
*
Does your pet have any chronic health problems we should know about?
*
Example Kidney disease, heart conditions, arthritis, diabetes or any known allergies.
Is your pet currently on any medication or special diet?
*
Have you already set up an appoinment with Bijou Animal Hospital
*
Yes
No
If yes, what is the date of your pet's appointment?
*
If no, would you like us to contact you to set up an appointment?
*
Yes, Please call.
Yes, Please email.
No, I will submit a request through the website.
No.
Has this pet been seen at another animal hospital or clinic? If yes, what is the name of the hospital or clinic so we can try to get copies of their medical history.
*
Do you have any Medical Records you would like to upload?
*
Max file size: 20MB
You can upload a single file. If you have several documents or images you can make a "zip file" to upload or you can email them to us at
[email protected]
Would you like to upload a picture for your pet's profile?
*
Max file size: 20MB
Profile pictures must clearly show the pet's face, and should not have any other pets in the picture. These pictures will only be used as a profile picture in the practice software & their petly profile.
Financial Policy
All outpatient fees are due at the time the service is preformed. Surgery and hospital fees are payable before the patient is released from the hospital. Bijou Animal Hospital accepts Cash, Checks, Mastercard, VISA, Discover, American Express, Apple Pay, A
ndroid Pay
and Carecredit*.
* Carecredit No Interest promotional offers are only available on purchases greater than $200.
I have read and agree to the above financial policy.
*
I Agree.
Submit
Home
About
Services
Contact
Meet the doctors
Meet the staff
Forms
New Client
Current Client with a New Pet Form