Online Form

New Client Form

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.

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New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pets before your visit.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Are we authorized to obtain previous medical records? *

Could you provide the name of your former veterinarian? This will enable us to reach out to them and acquire your historical records.

Upload previous pet medical history

Click or drag files to this area to upload. You can upload up to 4 files.

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Do you have a second pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Do you have a third pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Do you have a fourth pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Do you have a fifth pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed (copy) *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your pet. We accept credit cards (Visa, Mastercard, Discover, American Express), checks, cash, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

Schedule An Appointment

We proudly serve the pets of the Republic, Billings, Battlefield, Willard, Clever, Springfield, Mt. Vernon, Aurora, Marionville, Nixa, Monett, Halltown, Bois D’Arc, Ash Grove, Crane, Hurley, and surrounding communities. Call us today to schedule or book an appointment by clicking the button below!

Book Appointment

Have a Question?

Get in touch! We look forward to hearing from you.

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Location

574 E Harrison Street, Republic, MO 65738

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Contact Details

Phone: 417-732-6800
Fax: 417-732-6806
Email: rah417info@gmail.com

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Hours

Monday-Friday: 8 AM – 5 PM
Saturday: Closed
Sunday: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

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