New Client Form

Name: Spencer Creek Animal Hospital
Address: 520 Jungermann Rd., St. Peters, MO, 63376, United States
Telephone: 636-447-3727
Price range: $

A member of our team will reach out to confirm your appointment shortly.

Client Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Would you like to receive important medical information including reminders via E-Mail?(Required)

Yes

If YES to receive information via E-Mail please provide your E-Mail address:

Home Phone:(Required)

Emergency / Mobile Phone:

Work Phone:

Driver's Lic. #

Date of Birth(Required)

Patient Information

Pet's Name:(Required)

Species(Required)

Dog

Cat

Other

Sex(Required)

Male

Male Neutered

Female

Female Spayed

If you chose other, please list the species here

Date of Birth or Age(Required)

Breed(Required)

Color(Required)

Has your pet been on heartworm preventative?(Required)

Yes

Has your pet had any prior illnesses or surgeries of which you are aware?(Required)

Is your pet currently on a special diet or medication?(Required)

Are you aware of any drug allergies or reactions your pet may have? (please list)(Required)

Where can we call to get your pet’s previous medical history?(Required)

Date of most recent vaccinations:

Please provide the month and year of the latest vaccinations in the space provided below:

Rabies Vaccination(Required)

Distemper/Parvo Vaccination(Required)

Bordetella/Kennel Cough Vaccination(Required)

Stool Parasite Check(Required)

Lyme Vaccination(Required)

Distemper/Upper Respiratory Vaccination(Required)

Rabies Vaccination(Required)

Feline Leukemia Vaccination(Required)

FIP Vaccination(Required)

Stool Parasite Check(Required)

Feline Leukemia / FIV Test(Required)

General Information

How did you first become aware of our clinic's services?(Required)

Referral

Clinic sign/Location

Yellow Pages

Internet

Rescue Organization

Other

If you were referred to us by someone, may we have their name so that we may thank them?

If you chose other, please specify:

Do we have your permission to post pictures of your pet on social media?(Required)

Yes

Statement of Ownership and Consent

● I am the owner of the above described animal, or have authorization from the owner to consent to its treatment.

● I hereby authorize the performance of professionally accepted diagnostic, therapeutic, anesthetic, and surgical procedures necessary for its treatment whenever the animal is presented for care.

● I accept financial responsibility for these services.

● I have read and understand the above statement of ownership and consent.

Signature(Required)

Date

MM slash DD slash YYYY

Location



520 Jungermann Rd.
St. Peters, MO 63376

Click here for directions.

Contact Info



636-447-3727



wecare@spencercreekvet.com

Open Hours



Mon-Wed: 8am - 6pm
Thur: 8am - 4pm No DVM in clinic
Fri: 8am - 6pm
Sat: 8am - 1pm
Sun: Closed

Get in touch!

Our team is here to help! Complete the form below to get in touch. If you're in need of immediate assistance, please contact us at 636-447-3727.

Name *

First

Last

Email *

Phone

How can we help you? *

Comment

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