Client / Owner Information
Address
About Your First Pet
Species
How much information do you want to be given about your pet’s health?
Is your pet currently taking any medications (including heartworm prevention, flea/tick prevention, vitamins and supplements?)
Does your pet have allergies?
Has your pet ever had a reaction to vaccines or medications?
Species
How much information do you want to be given about your pet’s health?
Is your pet currently taking any medications (including heartworm prevention, flea/tick prevention, vitamins and supplements?)
Does your pet have allergies?
Has your pet ever had a reaction to vaccines or medications?
Marketing
Doctor Referral
City and State

You will be asked to sign a health plan confirming authorization of treatment after a tentative diagnosis. The details of treatment, the risks of treatment, and/or the risk of not treating will be explained to you.

I grant Lone Star Animal Hospital, its representatives and employees the right to take photographs of me and/or my pet, and to copyright, use and publish the same in print and/or electronically. I agree that Lone Star Animal Hospital may use such photographs of me and/or my pet with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content.

Please select one:

I hereby authorize the veterinarian to examine, prescribe for or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges must be paid in full, at the time of release of the pet.

Sign above