Kingsbury Animal Hospital

420 North Skinker Blvd.
Saint Louis, MO 63130

(314)721-6251

www.kah.com

New Client Check In

We ask that all new clients do the following:

  • Fill out our new client form (below)
  • Have your pets' records sent to us.  Email: doc@kah.com; or fax: 314.721.7513
  • Due to the high volume of calls and forms, it may take up to a week for us to contact you regarding the new client form. 
  • Upon scheduling the first appointment, you will be required to pay a $75 nonrefundable deposit.  This deposit will be applied to the balance at the end of the appointment.
  • If you fail to show for the scheduled appointment without notifying us, you will lose the $75 deposit. If you are more than 10 minutes late for your appointment, you may be subjected to either a $25 late fee and worked in, or a $75 no-show fee and rescheduled. 

New Client

CLIENT INFORMATION
Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,		State / Province (required)
Zip / Postal Code (required)
Main Contact Number (required)
Phone TypePhone Number (required)
WE COMMUNICATE FREQUENTLY VIA EMAIL. PLEASE BE SURE TO ENTER A VALID EMAIL ADDRESS!
Your E-Mail Address (required) :
Alternate Contact
First Name
Last Name
Alternate Contact Number

PATIENT INFORMATION
Pet's Name (required)

Type of Pet (required) :
Breed: (required)

Color: (required)

Sex: (required)

Male
Female


Neutered/Spayed
(Choose this option only if your pet has already been spayed or neutered)

Neutered
Spayed


Age: Years, Months or Date of Birth (required)

Name of Former Veterinary Practice

Phone Number of Former Veterinary Practice

Reasons or conditions that prompted your visit? (required)

Any previous serious illnesses or surgeries?

Any allergies to vacinations or medications ? (please list)

Is your pet on any special diet or medication?

Any special handling instructions / precautions we should be aware of when handling your pet?

I authorize Kingsbury Animal Hospital to photograph my pet and use said photographs on social media. *This release will remain in effect until you notify us in writing of any desired changes.* (required)

I agree
I disagree


IMPORTANT
We will gladly prepare a written estimate upon request. All fees are due at the time services are rendered. We accept all major credit cards, cash, and CareCredit. We DO NOT accept checks. Do you agree? (required)

Yes
No


Upon scheduling appointment, a $75 NON-REFUNDABLE deposit is required. This deposit will apply to the balance due of the first visit. If you do not give prior notice and do not show, you will lose the deposit. Do you agree? (required)

Yes


Do you understand and agree to the above statements? (required)
Yes, I understand and agree

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