Existing Client New Patient Registration

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We thank you for the opportunity to provide veterinary care for your pet.

Client Information

Preferred method of contact*



Address*















Treatment Consent

I hereby authorize the veterinarian to examine, prescribe for or treat the below-described pet(s) to the best of their abilities. I assume responsibility for all charges incurred in the care of this animal.

After hours emergency care is referred to either
K-State University Teaching Hospital (785)532-5690 or Veterinary Emergency & Specialty Hospital of Wichita (316)262-5321.

I give permission to release the following information regarding my pet(s) to inquiring veterinary, boarding, rescues, or grooming facilities.*



Photo Consent

Do we have your permission to share your pet(s)’ photos and/or videos of you and/or your pet?*


Pet Information

Species*


Sex*




If under a different person’s name, please list that name here.

Pet Pre-Visit Questionnaire

How would you describe your pet's reaction to going to the veterinary hospital?*




Are there any things that you or your pet did not like during past veterinary visits?*








Does your pet prefer:*



Can bring the treats or toy
Does your pet show any reluctance to get into the carrier or car?*


How and where does your pet travel in the car?*



How does your pet behave in the car?*







Any nausea, drooling or vomiting, with car travel?*


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785-823-2217

1501 South Ohio St., Salina, KS 67401

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