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BACK TO WEBSITE
Client Forms
- Arrival Check-in
- New Patient Form
Prescription Refill
Client Survey
Pay Online

(210) 651-1384

3929 Cibolo Valley Dr., Suite 200,
Cibolo, TX, 78108

Arrival Check-In

Pay Online

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New Patient Form

Marked Fields Are Required [*]

Business Name (If applicable):
Owners Name:*
First Last
Email
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone:
Cell Phone*
Work Phone
Would you like to add an additional owner(s) to the account?*
- YES
- NO
Additional Owners*
Full Name Phone# Relationship
Pet Information
Pet Name:*
Species:*
- Canine
- Feline
Sex:*
- Intact Male
- Neutered Male
- Intact Female
- Spayed Female
Pet's Age or DOB:*
Breed:
Color:
PAYMENT IN FULL IS EXPECTED AT TIME OF SERVICE

Professional fees are to be paid at the time services are rendered. We accept debit/credit cards, cash, & CareCredit. We do not accept checks.
Please indicate your preferred form of payment:*
- Cash
- Debit/Credit Card
- CareCredit
How did you learn about our hospital?*
I grant Cibolo Small Animal Hospital 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, with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising and Web content.*
- The above may take photos of me and/or my pet
- The above may NOT take photos of me and/or my pet
Professional fees are to be paid at the time services are rendered. We accept debit/credit cards, cash, & CareCredit. We do not accept checks. Please read carefully. Signature is required before exam or treatment. I hereby consent and authorize Cibolo Small Animal Hospital, Inc., its doctors and representatives to administer such treatment, diagnostic, surgical, and anesthetic procedures as they deem necessary. None of the above will be held liable or responsible in any manner whatsoever, under any circumstances, for the care, treatment or safekeeping of animals, as it is understood, I assume all risks. I hereby certify that I have read and fully understand the above authorization for medical and/or surgical treatment. I also agree that no guarantee or assurance has been made as to the results that may be obtained. Furthermore, I assume financial responsibility for all charges incurred to patient, consent to release of medical information, and authorize direct payment to Cibolo Small Animal Hospital. This practice’s financial policy is that payment is due at the time services rendered.
Consent*
I understand that I am financially responsible for payment of all bills for veterinary services, late charges, and collection costs.
Signature
Date
MM slash DD slash YYYY
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