Owner *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Cell Phone *

Home Phone

Partner/Co-owner

Partner's Phone

How did you hear about us?

Website
Sign
Referral

Pet Information

Pet Name *

Pet DOB/Age: *

Animal Type *

Dog
Cat

Breed: *

Color: *

Gender *

Male
Female

Is your pet spayed or neutered? *

Yes
No

Previous/Referring Veterinary Hospital: *

Insurance Company (if applicable): *

Please list all long term medications as well as any health problems:

Do you have a second pet? *

Yes
No

Pet 2 Name

Pet 2 DOB/Age:

Animal Type

Dog
Cat

Pet 2 Breed:

Pet 2 Color:

Gender

Male
Female

Is your pet spayed or neutered?

Yes
No

Please list all long term medications as well as any health problems:

Clinic Policies

In order to maintain the quality of care we provide for our patients, we have a number of policies in place which are outlined below. Please initial each point and sign at the bottom.

Appointment reminders: As a courtesy to you, we make every effort to email, text or call with an appointment reminder 24-48 hours before each scheduled appointment. If for some reason we do not remind you, the no-show/cancellation policy still applies if you fail to arrive for your appointment. *

I have read and understand.

Late Arrival: As a courtesy to our other patients/clients, we regret that late arrivals will not receive an extension of the scheduled appointment time, thus your treatment will be shortened if applicable. If you arrive late by 10 minutes or more, we reserve the right to deny treatment and charge the no-show/cancellation fee. If your pet has a rehab/treadmill/laser or acupuncture package, a session will be used in place of the no-show/cancellation fee. *

I have read and understand.

Treadmill/Rehab Patients: Patients must be clean, brushed out before hand, and free of any urinary tract or skin infections. Patients with diarrhea will not be permitted in the water treadmill. If a patient defecates in the water treadmill during any session, that session will immediately end and will be considered used. *

I have read and understand.

Packages: ALL Rehab, Laser and Acupuncture packages must be used within 12 months of purchase date otherwise they are not valid and you must repurchase a new package. No unused sessions of any package will be refunded for any reason. *

I have read and understand.

Payment: I understand that all fees/payments are to be paid at the time services are rendered. Understand that every effort has been made to enter all charges before invoicing, however any missed charges may necessitate additional billing. *

I have read and understand.

Cancellation Policy

Changes to your upcoming appointment, such as rescheduling or cancelling, must be made 24 hours before your scheduled appointment time. We require a Debit or Credit card on file, and a deposit for the examination/consultation in order to schedule an appointment. Failure to notify us 24 hours in advance of a reschedule or cancellation, will result in the deposit being applied towards a late cancellation fee. *

I have read and understand.

Defining a Late Cancellation:

Cancelling an appointment less than 24 hours before the scheduled appointment time.
Rescheduling an appointment less than 24 hours before the scheduled appointment time
Late arrival of more than 10 minutes to a scheduled appointment time (for any reason)
No arrival for a scheduled appointment

In the event of a late cancellation, our office will attempt contact, notifying you of the cancellation fee. Whether or not our office successfully makes contact, the cancellation fee will be charged or the deposit on file will be applied in place. We appreciate your respect and undertstanding of our clinic policies. These policies greatly help us provide effective, quality care to our clients and patients. *

I have read and understand.

By signing this form I acknowledge my agreement with all ascpects of this cancellation policy and Healing Hands Veterinary Hospital’s clinic policies. I also authorize Healing Hands Veterinary Hospital to bill me if I do not give the appropriate cancellation notice as outlined in these above policies. *

I have read and understand.

Alternative Therapy

I understand that the following treatments are considered alternative therapy and investigative by mainstream medicine: Acupuncture, Electro-acupuncture, Herbal Therapy, and Massage Therapy *

I have read and understand.

I authorize the staff of Healing Hands Veterinary Hospital to perform alternative therapy on my pet to include the above-mentioned treatments, and any other treatment plans that may be discussed between me (or responsible party), and the staff of Healing Hands Veterinary Hospital. The nature and purpose of the procedures, possible alternative methods of treatment, the risks involved and possibility of complications, have been fully explained to me. I acknowledge that no guarantee has been made to me regarding the results that may be obtained. I also understand that I have the right to discuss and have access to all traditional Western medical procedures and treatment methods if necessary or required. *

I have read and authorize alternative therapy.

Media Consent

Healing Hands Veterinary Hospital may use print photographs and other forms of media material of clients and/or pet(s) for educational, informational, and promotional purposes. Images may be used for, but is not limited to Healing Hands Veterinary Hospital publications, articles, newsletters, newspaper articles, advertising material, web listings, websites, social media, etc. This consent form will be kept on file by Healing Hands Veterinary Hospital as reference for individual approval. I understand that Healing Hands Veterinary Hospital will own all rights to the photographs, moving images, sound recordings, and other media and that I will not be compensated for any use. *

I Authorize Healing Hands Veterinary Hospital to take and use any photographs or media in any Healing Hands Veterinary Hospital publication, production, or presentation, including but not limited to electronic internet marketing material for the purpose of promoting Healing Hands Veterinary Hospital in a positive manner.
I DO NOT authorize Healing Hands Veterinary Hospital to take and use any photographs or media

ZERO TOLERANCE POLICY

We do not tolerate inappropriate behavior towards our staff.

We have a Zero Tolerance Policy for verbal abuse, demanding behavior, or displays of aggression.

Any client violating this policy will be denied future medical services from Healing Hands Veterinary Hospital.

We’re here to work together for your pet’s best health and welfare.

Thank you for your kindness and patience.

Signature *

Clear Signature

Online Forms:
New Client Form

Pet Information

Clinic Policies

Cancellation Policy

Alternative Therapy

Media Consent

ZERO TOLERANCE POLICY

We’re Excited to Meet You

Address

Contact Details

Hours

Have A Question?

We proudly serve the pets of San Antonio, TX and beyond.

Online Forms:New Client Form

Pet Information

Clinic Policies

Cancellation Policy

Alternative Therapy

Media Consent

ZERO TOLERANCE POLICY

Online Forms:
New Client Form