Date *

Name *

First

Last

Spouse/Co-Owner’s Name

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Work phone

Spouse/Co-Owner's phone

Place of employment *

Best time to reach you *

Email *

Please indicate your choice of payment *

All Fees Are Due At the Time Services Are Rendered

How did you become aware of our clinic? *

Client or personal recommendation, whom may we thank?

If other, please specify

Pet Information

Pet's name *

Breed *

Approximate age *

Color *

Sex *

Male
Neutered Male
Female
Spayed Female

Dog's Vaccination History

Please specify vaccination history for Rabies, DHLP Parvo, Bordetella, Fecal (stool sample), and Heartworm test/prevention.

Cat's Vaccination History

Please specify vaccination history for Rabies, PRCP, Leukemia test, and Fecal (stool sample).

Do you have a second pet? *

Yes
No

Pet's name *

Breed *

Approximate age *

Color *

Sex *

Male
Neutered Male
Female
Spayed Female

Dog's Vaccination History

Please specify vaccination history for Rabies, DHLP Parvo, Bordetella, Fecal (stool sample), and Heartworm test/prevention.

Cat's Vaccination History

Please specify vaccination history for Rabies, PRCP, Leukemia test, and Fecal (stool sample).

Do you have a third pet? *

Yes
No

Pet's name *

Breed *

Approximate age *

Color *

Sex *

Male
Neutered Male
Female
Spayed Female

Dog's Vaccination History

Please specify vaccination history for Rabies, DHLP Parvo, Bordetella, Fecal (stool sample), and Heartworm test/prevention.

Cat's Vaccination History

Please specify vaccination history for Rabies, PRCP, Leukemia test, and Fecal (stool sample).

Our pet(s) is *

Indoor only
Outdoor only
Equally indoor/outdoor
A child's pet

Any previous serious illnesses or surgeries? *

Any allergies to vaccinations or medications? *

Is your pet on any special diets or medications? *

Would you like to be present during treatment to your pet? *

Yes
No

Mutual Respect Policy

Our compassionate and knowledgeable team can answer your questions and concerns, including our client service representatives, veterinary technicians, veterinary assistants, and managers. All team members should be treated with the same respect as our doctors. If team members are relaying advice or information, they have been authorized and trained by the doctors to provide this communication. We take pride in mutually respectful relationships that benefit you, your pet, and us. *

I have read and understand

Client Rights & Responsibilities

At Bryan Animal Clinic, our mission is to help pets live their best lives through extraordinary care. We sincerely appreciate the trust you have placed in this relationship as we fulfill this mission with your pet. Like any good relationship, we believe clear and defined expectations and open communication are important. Because of this, we have created the client rights and responsibilities available below.

As a client, you have the right to: Accurate, clear, and impartial information regarding your pet’s health; Receive full explanations about our decisions; Know your pet’s diagnosis, prognosis, and treatment options including the risks and benefits, based on our capabilities and resources; Be informed of the costs of service we provide in advance of them being performed with some unforeseen expenses added; Participate in decisions regarding your pet’s care, including declining treatment options presented; A full explanation for why our staff may decline to treat your pet or provide a specific service; Share your questions, concerns, thoughts, or wishes and have them heard by our team; Considerate, respectful, and compassionate care and communication from our team; Fair and objective review of any complaint or problem; Assurance that your personal and medical information is handled in a confidential and private manner; Receive respect for your time and communication regarding any anticipated delays related to your appointment or follow ups. *

I have read and understand

As a client, you are responsible to: Disclose relevant, accurate, and complete medical and behavior history to our team, including previous medical records; Maintain a respectful and considerate demeanor when communicating with any member of our team; Share questions or concerns about anything we’ve discussed or left unaddressed; Honor your financial obligations and payment policies agreed to when your pet receives care; Help us provide care to other patients by abiding by our scheduling and appointment policies; Work collaboratively with your pet’s care team to develop and perform the agreed upon treatment plan including any necessary follow up visits and at home care; Be understanding of potential wait times due to unforeseen circumstances such as emergencies; Be aware of the consequences for actions or behavior inconsistent with this client rights and responsibilities document, including potential termination of the veterinary-client-patient relationship. *

I have read and understand

Scheduling Policies

At Bryan Animal Clinic, we provide high-quality, individualized medical care in a timely manner. In order to provide this care to as many patients as possible, we have implemented appointment scheduling and cancellation policies to ensure that we are able to help as many patients as possible.

Appointment Confirmations and Cancellations: As a courtesy, we will reach out via text, email, and phone to confirm your scheduled appointment. If you need to reschedule or cancel your appointment, please call 979-822-5953 within 48 hours of the reservation. If it is outside of our business hours or a team member is unavailable, you may leave a detailed message on our voicemail or email us at [email protected]. You will receive a confirmation of cancellation once this message is received. *

I have read and understand

Hospitalization and Emergency Procedure Deposits: A deposit of 50% will be required for any hospitalization/urgent surgical procedures. This amount will be applied to your final invoice and is determined based on the treatment plan the staff will provide to you. *

I have read and understand

Forfeited Appointments: Appointments are in high demand, and your early cancellation will allow another patient access to timely veterinary care. An appointment is considered forfeited in the following circumstances: Late arrivals exceeding 10 minutes after the scheduled start time. Any appointment canceled after 8:00 am the same day after confirmation has been given. Failure to confirm your appointment within 48 hours of the reservation. In the event of late arrival, our team can see your patient on a priority care basis. Wait times will vary. We ask that you arrive before your scheduled appointment time in order to benefit from the full exam time. New client and patient history forms should be completed in advance to help our medical team prepare for your pet’s visit. Our team can provide these to you upon arrival. If an appointment is forfeited, a fee in the amount of $20.00 will be charged to the account. This fee will need to be paid before any future appointments are scheduled. We strive to ensure clients and patients are seen in a timely manner and appreciate your on-time arrival. Clients who have three or more late arrivals for appointments cannot schedule future appointments and will only be seen as emergencies or day admissions. Additional fees will apply. *

I have read and understand

Financial Policies

Our financial protocols are in place to ensure we are able to keep our doors open and provide exceptional care to our patients and clients.

Deposits are required, along with a signed estimate, for hospitalized stays and/or procedures, with full payment due at the time of discharge. *

I have read and understand

We will always provide you with an estimate of services before they are completed. Full payment is due at the time of services rendered for appointments and outpatient visits. We accept Cash, Personal Checks, Visa, MasterCard, American Express, Discover, or Care Credit. If payment is made by check and is returned due to non-sufficient funds, there is a $50.00 returned payment processing fee. *

I have read and understand

Can we share your pet’s photo on social media? *

Yes
No

Preferred Contact Method *

Phone call
Text
Email

Signature *

Clear Signature

New Client Form

Pet Information

Mutual Respect Policy

Client Rights & Responsibilities

Scheduling Policies

Financial Policies

Questions?

Location

Contact Information

Hours