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318-435‑4585

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About
Services
- Large Animals
- Small Animals
Client Resources

Home
About
Services
- Large Animals
- Small Animals
Client Resources

Patient Registration Form

PATIENT'S NAME

CLIENT'S NAME(Required)

First Last

EMAIL

NUMBER WHERE YOU CAN BE REACHED TODAY

ALTERNATE NUMBER

PLEASE CHECK THE SIGNIFICANT PROBLEMS THAT APPLY TO YOUR PET

Vomiting

Seizures

Not eating

Inappropriate urination

Itchy skin

Diarrhea

Lethargy

Shaking head/ears

Limping

Eye issues

Unknown mass

PLEASE BRIEFLY DESCRIBE YOUR PET’S SYMPTOMS (DURATION, FREQUENCY, ETC.)

IS YOUR PET TAKING ANY MEDICATIONS? IF SO, WHEN WAS THE LAST DOSE GIVEN? (DURATION, FREQUENCY, ETC)

ANY OTHER COMMENTS OR QUESTIONS FOR THE DOCTOR?

IT IS VERY IMPORTANT THAT THE DOCTOR IS ABLE TO CONTACT YOU IF HE/SHE HAS QUESTIONS REGARDING YOUR PET. FAILURE TO BE CONTACTED MAY RESULT IN POSTPONEMENT OF DIAGNOSTICS AND TREATMENT.DO YOU APPROVE OF DIAGNOSTIC TESTING SUCH AS BLOOD WORK AND/OR X-RAYS IF YOUR DOCTOR FEELS IT IS WARRANTED?

Yes, please proceed with what the doctor recommends.

No, please contact me prior to performing any diagnostic testing.

Consent(Required)

I understand and agree to the terms below.

DROP OFF EXAMS ARE OFFERED FOR YOUR CONVENIENCE, THEREFORE, THERE WILL BE A $13 MEDICAL DAY BOARDING FEE. YOUR PET WILL BE EXAMINED WHEN THE DOCTOR’S SCHEDULE ALLOWS BUT IF YOU NEED TO PICK UP BY A CERTAIN TIME, WE WILL TRY OUR BEST TO ACCOMMODATE YOUR SCHEDULE.

25652

Contact Us

6355 LA-4
Winnsboro, LA 71295

Phone: 318-435-4585

Clinic Hours

Mon-Fri: 8am–5pm
(Closed for lunch from 12pm-1pm)
Tue: Ex Hours (By Appt Only): 5pm–6:30pm
Sat: Closed
(Open 8am–9am for boarding drop-off/pickup & discharges only)
Sun: Closed
After-Hours: Case by case. When unavailable, referrals go to Animal Emergency Clinic of Northeast LA

Request an Appointment
Pet Record Sign-up
Rx Refill Request

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