Client / Patient Registration

We ask that you please also fill out the Pre-visit questionnaire to the best of your ability so we can take into consideration both you & your pet’s preferences.
  • Client Information

  • Date Format: MM slash DD slash YYYY
  • Pet Health Information

  • Date Format: MM slash DD slash YYYY
  • Authorizations / Financial Policy

  • I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment. 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.
  • We require payment in full at the end of your pet’s examination and/or at the time of the discharge. Payment Options: You can choose from: Cash, Check, Visa, MasterCard, Discover, AmericanExpress or Care Credit. We charge 18% interest on all outstanding account balances older than 30 days. Town and Country Animal Hospital may relinquish your balance owed to a collection agency. If the account is turned over to a collection agency there is a one-time collection fee of $35.00 that is added to the account prior to turn over. We also charge $30.00 for returned checks. For clients with pet insurance, we are happy to provide you with the necessary documentation to submit a claim to your insurance carrier. If you have any questions please do not hesitate to ask. We are here to provide the best veterinary care available to your pet.