Skip to content
770-445-7300
MAKE AN APPOINTMENT
Home
Our Doctors
Services
Wellness Exams
Vaccinations
In-House Laboratory
Surgery
Dental Care
Microchipping
Spay & Neuter
View All Services
Forms
Shop Online
Careers
Contact Us
Home
»
Forms
»
Welcome Letter
Welcome Letter
Thank you for giving us the opportunity to care for your pet. We will be happy to answer any questions you may have about your pet’s health. To ensure the best care possible, please take the time to fill in this form completely. Thank you!
Owner
Spouse
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Home #
Cell #
Work #
Email
(Required)
Would you prefer to receive reminders by email or regular mail?
Email
Regular Mail
Spouse Work #
Spouse Cell #
Emergency Contact Name
Phone #
How did you learn about us?
Yellow Pages
Location
Sign
Recommendation
If recommended, by whom:
Pet Health History
Name of Pet
Type
Dog
Cat
Other
Breed
Color
Date of Birth
MM slash DD slash YYYY
Gender
Male
Female
Male Neutered
Female Spayed
East Paulding Animal Hospital is dedicated to providing outstanding medical care for all of our patients. All pet foods we carry are guaranteed by the manufacturer for 100% customer satisfaction. All other sales are considered final after the services are rendered, if you have concerns please contact us and we will work with you to try and resolve them as quickly as possible.
Authorization
I hereby authorize the veterinarian to examine, prescribe for and/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, that I am responsible for any accrued finance charges for any unpaid balances, and that a deposit may be required for treatment. If there is an unpaid balance and the account is sent to collections, there will be a $50.00 fee.
Signature
(Required)
Date
MM slash DD slash YYYY
Mode of Payment
Cash
Debit
Check
Visa/MC
Amex/Dise
Care Credit
CAPTCHA
Get in touch
770-445-7300
3041 Charles Hardy Parkway,
Dallas, GA 30157
Make an appointment
Make an Appointment
Find Us
Pet Records
Online Pharmacy