Ranson Animal Hospital

Providing Exceptional Care and Quality Service for You and Your Pet!

407 North Mildred St
Ranson, WV 25438

ph: 304-724-5055
fax: 304-724-7053

ransonanimal1@gmail.com

  • Home
  • About Us
  • Services
  • Hospital Hours and Emergency Hours
  • Emergency Contact Information
  • Hospital Photographs
  • Contact Us
  • Client ServicesClick to open the Client Services menu
    • Facebook Link
    • Pre-surgical Instructions
    • New Client Information Forms
    • Client Surveys
    • Care Credit Information
    • Euthanasia Education
    • Purina Veterinary Diets
    • Poison Control Information
    • Health Certification and Travel Information
  • Interesting CasesClick to open the Interesting Cases menu
    • Lucia's Surgery
    • Elizabeth's Dental
    • Routine Neuter (canine castration)
    • Routine Spay (ovariohysterectomy)
    • Bogaurd's fracture
    • Mya's nose surgery

New Patient/Client Information Forms

PATIENT / CLIENT INFORMATION

 

Thank you for giving us the opportunity to care for your pet(s). So that we may become better acquainted with you and your pet, please complete the following:

(Please Print)

PRIMARY OWNER

 

Name:     ______________________________________________________________________

                 Last                                            First                                          Middle Initial

Address:  ______________________________________________________________________

                 P.O. Box Must Include Physical Address

                 _____________________________________________________________________

                 City                                           State                                              Zip Code

Owner’s Driver’s License # ________________________________________

Home Phone:  __________________________________________________

Work Phone:  __________________________________________________

Cell Phone:  ____________________________________________________

Employer:  _____________________________________________________

E-mail Address:  ________________________________________________

 

 

                                        SPOUSE / SIGNIFICANT OTHER 

 

Name:     _____________________________________________________________________

                 Last                                       First                                       Middle Initial

Address:  _____________________________________________________________________

                  P.O. Box Must Include Physical Address

                  ___________________________________________________________________

                  City                                              State                                         Zip Code

Driver’s License # _________________________________________________

Home Phone:  ____________________________________________________

Work Phone:   ____________________________________________________

Cell Phone:   _____________________________________________________

Employer:  _______________________________________________________

E-mail Address:  ___________________________________________________

 

                      PET INFORMATION                             

 

 

INFORMATION

PET #1

PET #2

PET #3

Pet’s Name

 

 

 

Species (Canine/Feline)

 

 

 

Breed (Poodle, etc)

 

 

 

Color

 

 

 

Age/Date of Birth (if known)

 

 

 

Sex

Male             Female

Male                  Female

 Male                 Female

Spayed (F)      Neutered (M)

Yes                  No

 Yes                      No

  Yes                      No

Vaccination History (Dates)

 

 

 

Rabies (Canine/Feline)

 

 

 

Canine Distemper

 

 

 

Bordetella (Canine)

 

 

 

Lyme (Canine)

 

 

 

Heartworm Test (Dog/Cat)

 

 

 

Combo Test (Feline)

 

 

 

Feline Distemper

 

 

 

Feline Leukemia

 

 

 

Other

 

 

 

 

 

Signature:  ___________________________________________  Date:  ____________________

 

PLEASE READ AND SIGN OUR FINANCIAL POLICY ON REVERSE SIDE

 

OUR MISSION

The mission of Ranson Animal Hospital is to fulfill the needs of our clients by providing quality pet health care services through a responsive, professional staff with the emphasis on individual attention and commitment to our clients, their pets, and our community. We will never be the reason any pet does not have the opportunity for the best care veterinary medicine has to offer.

 

OUR FINANCIAL POLICY

Our hospital does not receive financial support from charitable organizations or government agencies. Therefore, prompt payment assures maintenance of a well-equipped, properly stocked facility, as well as a professional medical staff to insure the highest level of quality care which we strive to provide. Due to the fact that prompt payment must be insured in order for us to provide this level of care, the following financial policies are required:

  • Payment in full is required for all routine services at the time of service. For your convenience, we accept cash, personal check, credit/debit cards (Visa, Master Card, and Discover) for the amount of the invoice only.
  • A minimum of 50% of the estimate is required as a deposit at the time of admission for all major surgical procedures and hospitalization. However, elective surgeries do not qualify and must be paid in full at the time the pet is released from the hospital.
  • Emergency cases require a minimum of 50% of the written estimate at the time of admission of the pet the hospital.
  • Our financial policy strictly prohibits the establishment of any charge accounts at this time.
  • Care Credit is also available – ask a staff member for details.

                                                                                                

 

We thank you in advance for your time and consideration of this policy

 

Signature:  _________________________________________ Date: ______________________

 

 

Copyright 2010 Ranson Animal Hospital. All rights reserved.

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407 North Mildred St
Ranson, WV 25438

ph: 304-724-5055
fax: 304-724-7053

ransonanimal1@gmail.com