New Patient Form

If your pet is a new patient at Carolina Veterinary Specialists in Huntersville, please fill out our New Patient form using one of the options below.

OPTION 1
Fill Out Online

Complete the online form below and submit.

OPTION 2
Print & Complete

Once completed, bring the form with you.

Download Form

OPTION 3
Complete in Office

If you prefer, you can fill out the form when you arrive at our hospital.

New Patient Form

Please provide us with the following information.

Important: If your pet is an avian or exotic patient, please also download and complete the appropriate questionnaire.

Owner Information

Owner First Name *

Owner Last Name *

Secondary Owner / Authorized Agent Name

Email *

Primary Phone *

Alternate Phone

What is the best way to reach you? *

Address *

City *

State *

Zip Code *

Occupation *

Place of Employment *

Patient Information

Patient Name *

Birth Date / Age *

Species *

Breed / Other Species *

Color

Vaccination Status *

Gender *

Spayed or Neutered? *

Describe in detail why your pet is being presented *

Payment & Insurance

PAYMENT IN FULL IS EXPECTED AT THE TIME SERVICES ARE RENDERED. Prior to the treatment of your pet we will provide you with an itemized estimate. It is the policy of Carolina Veterinary Specialists to require a deposit on all hospitalized patients and those outpatients having extensive diagnostic or treatment procedures. Please ask our client care team if you have any questions.

Do you carry pet insurance? *

If yes, what is the name of your insurance company?

Referral Information

How did you hear about us? *

Veterinarian Referral (please provide details below)

Friend / Family

Internet

Community Event

Signage

Printed Publication

Radio

Other

If you have been referred to us by another veterinarian, please state the name of the veterinarian or animal hospital that referred you to us

Referring Hospital Name *

Referring Veterinarian Name *

Spam Blocker

New Patient Form

OPTION 1
Fill Out Online

OPTION 2
Print & Complete

OPTION 3
Complete in Office

New Patient Form

Owner Information

Patient Information

Payment & Insurance

Referral Information

Caring for Pets in Huntersville

Important Information For Clients Regarding COVID-19 Virus. Click Here

New Patient Form

OPTION 1Fill Out Online

OPTION 2Print & Complete

OPTION 3Complete in Office

New Patient Form

Owner Information

Patient Information

Payment & Insurance

Referral Information

Caring for Pets in Huntersville

Important Information For Clients Regarding COVID-19 Virus. Click Here

OPTION 1
Fill Out Online

OPTION 2
Print & Complete

OPTION 3
Complete in Office