"*" indicates required fields

Welcome to Bigger Road Vet!

To ensure the best care possible, please take the time to fill out our new client form within 24 hours of scheduling your appointment. We understand that this form is thorough. Please allow 15 minutes to complete it.

Is your scheduled appointment at Kettering or Springboro location?*

Kettering

Springboro

Owner Information

Owner’s Name*

First Name

Last Name

Owner’s Date of Birth*

MM slash DD slash YYYY

Address*

Street Address

City

State

ZIP Code

Primary Phone*

Primary Email*

Additional Pet Caregiver (Roommate, Spouse, Partner)

*Please only list an additional caregiver if they are authorized to make medical decisions on behalf of your pet.

Name*

First

Last

Address (if different than primary caregiver)

Street Address

City

State / Province / Region

ZIP / Postal Code

Primary Phone*

Pet Information

Pet’s Name*

Species*

Dog

Cat

Breed*

(Required – Please put “unknown” if you’re not sure)

Date of Birth or Age*

(Required – if unknown please approximate with “Puppy”, “Adult” or “Senior”)

Colors & Unique Markings*

Gender*

Neutered (fixed) Male

Unaltered Male

Spayed (fixed) Female

Unaltered Female

Unsure

Does your pet have any ongoing/recurring medical concerns?*

(Examples: chronic yeast infections, recurring ear infections, previously diagnosed Lymes disease, arthritis, etc)

Has your pet had any surgery other than a spay or neuter?*

Please list the name of the surgery and approximately when it was completed.

Does your pet have any known allergies?*

Has your pet ever been reactive or aggressive towards other pets or people in a veterinary office or similar setting?

If yes, please explain in detail so we may do our best to make this a pleasant and safe experience for all.

Medical Records

Previous Veterinarian*

(Required – Please put N/A if your pet has never been to a vet)

Previous Vet's Phone Number

May we contact them to get records?*

Yes

Additional Information

Do you own any additional pets?

Yes

Pet #2 Name

Pet #2 Species

Dog

Cat

Pet #2 Breed

Pet #2 Date of Birth or Approximate Age

Do you own any additional pets?

Yes

Pet #3 Name

Pet #3 Species

Dog

Cat

Pet #3 Breed

Pet #3 Date of Birth or Approximate Age

Do you own any additional pets?

Yes

Pet #4 Name

Pet #4 Species

Dog

Cat

Pet #4 Breed

Pet #4 Date of Birth or Approximate Age

How did you find out about our hospital?

Google (or another search engine)

Social Media

Hospital Sign / Drove By

Hospital Flyer / Postcard

Recommendation

Other

Whom May We Thank

First Name

Last Name

Do you consent to photos of your pet(s) being posted in hospital or on our website and/or social media accounts without the expectation of compensation?

Yes

Hospital Policies

Estimates: We are happy to provide an estimate before treatment begins. However, estimated costs are subject to change based on the needs of your pet and/or the care deemed necessary by our staff.

Termination of Service: To provide effective veterinary care, there needs to be a certain level of mutual respect between hospital staff and clients. We reserve the right to refuse or terminate service to anyone for any reason not prohibited by law.

Payment: We accept a variety of payment options for client convenience. Payment in full is expected at the time services are rendered.

Cancellation / Rescheduling: We kindly require at least 24 hours’ notice before the cancellation of an appointment. We reserve the right to reschedule an appointment if the pet arrives more than 10 minutes past the scheduled appointment time.

By signing the below, I agree to comply with hospital policies and confirm that all of the information provided is accurate to the best of my knowledge.

Signature*

Date*

MM slash DD slash YYYY

New Client Form

Owner Information

Additional Pet Caregiver (Roommate, Spouse, Partner)

Pet Information

Medical Records

Additional Information

Hospital Policies