New Client Form

Welcome to Midtown Veterinary Hospital!

appointment

Compassionate veterinary care for the pets of Houston, TX.

Our goal is to provide personal and precise care, supported by cutting-edge technology and contemporary veterinary techniques. We deliver this standard of care in a friendly and supportive setting.

New Client Information

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. If this is an emergency, or if your pet needs urgent care, please call us at (713) 528-4900 for a faster response.

Owner Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

As a paper-lite facility, most of our communication will be via e-mail. Please let us know if e-mail communication is not a good option for you.

Primary Phone *

Secondary Phone

How did you hear about us?

Drove By
Google
Facebook
Yelp
Other
Referral

If other, please explain how you found us!

If you were referred by someone, who should we thank?

Secondary Owner

First

Last

Phone

Pet's Name *

Breed *

Color *

Age/Date of Birth (copy) *

Sex *

Male
Neutered Male
Female
Spayed Female

Previous Vet Hospital (if applicable)

If listing a vet facility, please note if your pet’s medical records are under a different person’s name.

Allergies/Conditions

Current Medications (Including Heartworm and Flea prevention)

CANCELLATION POLICY: In accordance with the cancellation policy of Midtown Veterinary Hospital, I understand failure to show up to my appointment, or call before the appointment to cancel will result in a charge of $69.98 *

I have read and accept the financial policy.

We want your pet to be Facebook Famous! At Midtown Veterinary Hospital we sometimes publish our patient’s cute photos or case studies. Do we have your permission to do so? *

Yes. I will allow MVH to use my pet’s image/information on their social media page.
No. I will not allow MVH to use my pet’s image beyond their private medical history.

Owner Signature *

Phone

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