Tri County Animal Hospital

22285 St. Rt. 62 E
Alliance, OH 44601

(330)821-0397

tri-countyanimalhospital.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 cooperation in letting us assist you.

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 :
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed:

Sex: (required)
Male
Female


Neutered/Spayed
Neutered
Spayed


Are your pets vaccines current?
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


Would you like us to call you for your appointment?
Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here

Please Read
I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this pet. I also understand that these charges will be paid at the time of service and that a deposit may be required for hospitalization and/or surgical treatment.
I have read this statement and - (required)
I Agree
I Disagree


Please Read

I have read this statement and - (required) :

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HOURS


Day Open Close
Monday 8:00am 7:00pm
Tuesday Closed Closed
Wednesday 8:00am 7:00pm
Thursday 8:00am 7:00pm
Friday 8:00am 5:00pm
Saturday Closed
Closed
Sunday Closed Closed

** We do surgeries on Wednesdays and Thursdays. Drop offs for surgeries are at 8:15 am, & No food after midnight.**

 

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