Welcome to McPhillips Animal Hospital!

Client/Patient Information

Please provide the first and last names and contact information of all persons who are authorized to decide on the treatment of and accept financial responsibility of all pets under client number. These are the only people who can be given any information regarding treatment performed at this hospital, due to the privacy information act.

Date
Client Information
Primary Caregiver
Secondary Caregiver
Name*
First Last
Name
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Relationship to Primary Caregiver
Phone*
Cell Number*
Work Number
Place Of Employment
Business Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Enter Email Confirm Email

Please note that your email address is collected only to use in communications from our hospital, we do not share your email address with any third parties.
How did you find out about McPhillips Animal Hospital?
- referred by another clinic
- yellow pages
- referred by friend/relative
- noticed our sign
- internet
If Other, please specify:
If you have been referred by a friend/relative, we would like to thank them, please supply their contact information below.
ALL FEES ARE DUE AT TIME OF SERVICES RENDERED
We accept CASH, DEBIT, VISA, MASTERCARD, AMEX We do not accept cheques.

NOTE: TO PREVENT THE SPREAD OF INFECTIOUS DISEASES, ALL HOSPITALIZED PATIENTS MUST BE CURRENT ON ALL VACCINES AND FREE FROM INTERNAL AND EXTERNAL PARASITES. THE SIGNATURE BELOW AUTHORIZES THIS LEVEL OF PREVENTATIVE CARE AND THE APPROPRIATE CHARGES WILL BE ASSESSED IN THE DISCHARGE INVOICE.
Patient Information
Pet 1 Name*
Pet 2 Name
Pet 3 Name
Breed (if known)
Breed (if known)
Breed (if known)
Date of Birth or Age (if known)
Date of Birth or Age (if known)
Date of Birth or Age (if known)
Color
Color
Color
Sex
Sex
Sex
Has your animal been previously vaccinated?
- Yes
- No
If Yes, when was the last vaccine given: Rabies:
Distemper:
Other:
Would you like a reminder for vaccinations?
- Yes
- No
Where did you obtain this pet?
- Friend
- Breeder
- Pet Shop
- Humane Society
For what purpose was this pet obtained?
- Companion
- Protection
- Breeding
- Show
Other
Other

Welcome to McPhillips Animal Hospital!

Client Information

Primary Caregiver

Secondary Caregiver

Patient Information

HOSPITAL HOURS

CONTACT US

DIRECTIONS