(573) 861-0102
hello@jeffersoncityanimalhospital.com
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DIRECT ONLINE BOOKING – NOW AVAILABLE

New Client Form

Save time during your next appointment. Complete your required forms online from any device at any time before your visit.

a cat wearing a cone

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a second pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a third pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fourth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fifth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your Pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your Pet. We accept cash, Visa, MasterCard, Discover, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

Email

We Can’t wait to meet you!

We’re proud to provide veterinary services to dogs and cats from Jefferson City and beyond! Have a question for our team?

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Location

1250 W Stadium Blvd
Jefferson City, MO 65109

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Contact Information

Phone:
(573) 861-0102

Email:
hello@jeffersoncityanimalhospital.com

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Hours

Mon – Fri: 8:00 AM – 5:30 PM
Sat: 8:00 AM – 12:00 PM
Sun: Closed

Have a Question?

Get in touch! Complete our form, and a member of our team will be in touch with you shortly.

Name *

First

Last

Email *

Phone

How can we help you? *

Message

PetDesk-app

Download our app!

Keeping up with your pet’s health from your mobile device has never been easier! With our new app, you’ll have all of your pet’s health information in the palm of your hand. Consider it your Pet’s personal organizer app. Best of all it’s free! Plus, you’ll be able to communicate with us much easier:

Access Your Pet’s Medical Records
Organize all of Your Pet’s Important Information
Receive Automatic Reminders
Save Notes, Pics, and Much More
Two-Way Texting With Our Team

We proudly serve the pets of Jefferson City and beyond

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Jefferson City, MO

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