812-246-6146
info@carepetsah.com
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 812-246-6146

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fill out our forms today!

New Client Form

Fill out our new client from before your first visit with us!

fill out our forms today!

New Client Form

Fill out our new client from before your first visit with us!

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Primary Phone *

Secondary Phone

Spouse/Emergency Contact Name *

First

Last

Spouse/Emergency Contact Phone *

How did you hear about us? *

Yellow Pages
Sign/Location
Website
Personal Recommendation
Other

Who should we thank for the recommendation? *

If other, please specify *

Pet's Name *

Species *

Dog
Cat
Other

If other, please specify *

Breed *

Color *

Sex *

Male
Neutered Male
Female
Spayed Female

Age/Date of Birth *

Add another pet? *

Yes
No

Pet's Name *

Species *

Dog
Cat
Other

If other, please specify *

Breed *

Color *

Sex *

Male
Neutered Male
Female
Spayed Female

Age/Date of Birth *

Add another pet? *

Yes
No

Pet's Name *

Species *

Dog
Cat
Other

If other, please specify *

Breed *

Color *

Sex *

Male
Neutered Male
Female
Spayed Female

Age/Date of Birth *

Previous Veterinarian

Previous Veterinarian Contact Info

Photo Release: I grant to Care-Pets 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 Care-Pets 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. *

I accept
I deny

I hereby authorize the veterinarians of Care-Pets Animal Hospital to examine, prescribe for, and treat the above described pet(s). Any animal admitted or hospitalized shall receive the necessary diagnostic tests and treatment to ensure proper medical care and to prevent the spread of infectious diseases and parasites. I agree to pay for all services rendered and medications, goods, and supplies when purchased. I understand that a deposit may be required for surgical or medical treatment. ALL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. *

I have read and accept the financial policy.

By my signature below, I hereby agree to all of the above and acknowledge the receipt of a copy of this agreement (upon request). *

Clear Signature

Signature

Date *

Email

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Ready for a visit?

If you live in Clark or Floyd County, just north of Louisville, and need trusted veterinary care for your pets – look no further. At Care-Pets Animal Hospital and Wellness Center, your pets are our pets! Easily book an appointment for your pet using our online system.

Book Appointment

Have a question?

Complete our online form, and a member of our team will be in touch with you shortly.

Address

8800 Old State Rd 60, Sellersburg, IN 47172



Contact

E: info@carepetsah.com
Call or Text: 812-246-6146



Hours

Monday – Friday: 8am – 12pm | 2pm – 6pm
Saturday: 8am – 12pm
Sunday: Closed

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Email *

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Holiday Hours

We are closed on New Years Day, Memorial Day, Fourth of July, Labor Day, Thanksgiving Day and Christmas Day.

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