New Client Form

Name: Grantview Animal Hospital
Address: 11319 Gravois Road, St. Louis, MO, 63126, US
Telephone: 314-842-0403
Price range: $$

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New Client Form

Thank you for choosing Grantview Animal Hospital for the care of your pet. Please take the time to fill out the Client/Patient Registration form as completely as possible. This will allow us to serve you better! Also, please ensure your pets previous medical records are submitted prior to your pets first appointment. We look forward to meeting you and your adorable pets!

Name
First Last
Drivers License Number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone
Other Phone
Email
Alternate Contact Name
First Last
Alternate Contact Phone
How did you hear about us?
- Google/Online
- Facebook
- Yelp
- Word of mouth
- Other
Who can we thank for your visit today? Ask us about our referral program!
Pet's Name
Nickname
Species
Breed
Sex
Color/Markings
Date of Birth
Date Format: MM slash DD slash YYYY

Leave blank if unknown
How long have you owned this pet?
Vaccines: please list previous vaccine history. List vaccine and date it was given.
Is your pet on Heartworm or Flea/Tick Preventitve? If yes, please list the product and the date it was last given.
Please list any medications or special diets your pet is on.
Any previous illnesses, surgeries, allergies or drug sensitivities? Please explain.
We will use various fear free techniques during your pets visits. Commonly, this involves giving treats. Please let us know what treats to avoid and most importantly if anyone in your immediate family has a peanut allergy.
May we take and share pictures of your adorable pet on our social media accounts or slideshow in our lobby?
- Yes
- No
Please select the following places we may share your pets' medical/vaccine information:
- Kennels/Daycare
- Grooming
- Rescues
- Veterinary Clinics
- I Decline
- Other
Please specify if other:
Do you have any additional questions or concerns you would like to discuss? Is there anything else you would like us to know about your pet?
Consent
I agree
ALL FEES ARE DUE AT THE TIMES SERVICES ARE RENDERED. WE ACCEPT CASH, CHECKS, VISA, MASTERCARD, DISCOVER and CARE CREDIT. I agree to pay any additional charges related to the cost of collection (including but not limited to collection agency fees, reasonable attorney fees and court costs), in the event I would fail to pay my bill in full.

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Location Hours

Monday	8:00am – 5:00pm
Tuesday	8:00am – 8:00pm
Wednesday	8:00am – 5:00pm
Thursday	8:00am – 8:00pm
Friday	8:00am – 2:00pm
Saturday	8:00am – 2:00pm
Sunday	Closed

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