Online Forms

New Client Form

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online forms

New Client Form

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone *

Home Phone

Work Phone

Driver's License Number *

Birth Date *

Email *

Significant Other

First

Last

Significant Other Phone

**The person who has completed this paperwork has agreed to and is responsible for the financials of this account and the animals involved.

Pet Information

Pet's Name *

Species (dog, cat, etc.) *

Age/Date of Birth *

Breed *

Color *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Is your pet indoor or outdoor? *

Previous Veterinarian

Do you have a second pet? *

Pet's Name *

Species (dog, cat, etc.) *

Age/Date of Birth *

Breed *

Color *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Is your pet indoor or outdoor? *

Previous Veterinarian

Do you have a third pet? *

Pet's Name *

Species (dog, cat, etc.) *

Age/Date of Birth *

Breed *

Color *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Is your pet indoor or outdoor? *

Previous Veterinarian

How did you hear about us?

Pet Insurance Information

If you require us to file with your insurance, on your behalf, additional fees may apply.

Does your pet have insurance? *

Provider *

Policy number *

Payment and Hospital Policy

Signature *

Clear Signature

Date *

Thank you for choosing Four Paws Animal Hospital as your veterinary health care provider. We are committed to your pet’s treatment being successful and as cost effective for you as possible, while maintaining an atmosphere of superior customer service and patient care. The following is a statement of our Financial Policy. We ask that you please read and sign below. Full payment is due at the time service is rendered. We accept cash, debit, Visa, Mastercard, Discover, American Express, and Care Credit. If there are any questions regarding fees or charges, please inform your customer service representative or technician before any services are performed. We DO NOT offer payment plans of any kind. All discounts must be applied at the time of check-out and cannot be applied retroactively. Before any pet is admitted into the hospital, a deposit will be required before services are rendered with the balance due upon release. In the event that a client refuses payment at any time for any reason, Four Paws Animal Hospital reserves the right to pursue legal action and file charges against that client for Theft of Services. Four Paws Animal Hospital will make every effort to collect payment expeditiously prior to charges being filed or legal action being pursued. Four Paws Animal Hospital is not an animal shelter and does not accept surrenders. Any animal left in custody of the clinic for longer than 5 days past the scheduled pick-up date and time, with no effort made by the owner to communicate, shall be considered abandoned. Any animal abandoned at Four Paws Animal Hospital will be dealt with according to the discretion of the Four Paws Animal Hospital staff. Four Paws Animal Hospital will always make every effort to communicate thoroughly and effectively regarding the pricing of and payment for services. It is the responsibility of both the clinic staff and the client to practice effective communication. We commit to always being honest, open, and willing to communicate with clients. Four Paws Animal Hospital makes every effort to respect the time of it’s clients and employees. For this reason, any client arriving more than 15 minutes late for a scheduled appointment will be rescheduled. In the event that an appointment is made, and not kept, a “No Show” fee of $25 will be assessed. Any requests for records or prescriptions must be made at least 24 hours in advance. Regarding Pet Insurance: As the pet owner, it is your responsibility to file claims with your pet’s insurance provider. If you require us to file with your insurance, on your behalf, additional fees may apply. CareCredit Policy: Purchases totaling more than $200.00 are eligible for interest-free financing up to 6 months. Any CareCredit charges totaling less than $200.00 will be subject to the interest rates set by CareCredit. You understand that photo and video may be taken of your pet while participating in FPAH activities, and that these photos and videos may be featured on our website or other FPAH material and social media.

I understand

Website

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Book an Appointment in Rowlett, TX

At Four Paws Animal Hospital, we treat your pets like the valued family members they are. We proudly serve the pets of Rockwall, Garland, Sachse, Wylie, and beyond. We look forward to seeing you and your pet!

Easily book an appointment for your pet using our online system.

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Address

5620 Rowlett Rd.
Rowlett, TX, 75089

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Hours

Mon-Fri: 7:30 am-5:30 pm (Closed from 12 pm-1:30 pm for staff development)
Sat-Sun: Closed

Contact

P: 972-475-7696
F: 972-475-6465
E: fpah@fourpawsinfo.com

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