Housecall Veterinary Services
Housecalls by Appointment....We come to you.


Housecall Veterinary Services
Dr. Karen La Vergne
New Braunfels, TX
(830)606-7867 or drkaren2222@yahoo.com




New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

Thank you for your cooporation in letting us assist you.


No Description

Form - New Client

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
State/Province (required)
Zip/Postal Code (required)
,
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Pet's Name (required)

Age: Years, Months (required)

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

Sex: (required)
Male
Female

Neutered/Spayed (required)
Neutered/Spayed
Intact

Do you have pets medical records?
Medical records at another veterinary Practice?
Yes
No

Name of Former Veterinary Practice

May we request a transfer of records?
Yes
No

Reasons or conditions that prompted your call?

Special requests or conditions?

Please list any additional pets here

How did you hear about us?

Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of Housecall Veterinary Services and that charges are due and payable at the time of service, unless other arrangements are made in advance.
I have read this statement and - (required)
I Agree
I Disagree


The verification code below ensures the form is not submitted by a computer
Verification Code :
Enter the code you see in the graphic below in this box.
Your post will not be allowed if you do not type this in correctly.