Abri Veterinary Hospital

New Client Form

Save time during your next appointment! Complete your required new client form online from any device at any time before your next visit.

Get Started

We Look Forward To Seeing You!

Please complete the form below before your first visit.

If you need immediate assistance, please call us directly during business hours at 336-785-9228.

Name *

First

Last

Spouse/Co-Owner's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Secondary Phone *

Spouse/Co-Owner's Phone

Email *

Your email will only be used for hospital-related correspondence and medical reminders.

Preferred payment method (select all that apply) *

Cash
Check
Credit/Debit Card
CareCredit

Please note that all fees are due at time of services rendered.

Pet's Name *

Species *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Is your pet allergic to any medications or vaccinations? *

Is your pet currently taking any medications? *

I authorize Abri Veterinary Hospital to release medical information to other hospitals, groomers, and kennel facilities. *

I authorize
I do not authorize

I grant Abri Veterinary Hospital permission to post my pet's pictures and stories on the hospital's social media pages. *

I grant permission
I do not grant permission

I authorize Abri Veterinary Hospital to release basic contact information (phone number) in the event that my animal is lost and recovered by another individual *

I authorize
I do not authorize

As a new client, I understand that is my responsibility to provide previous/additional vaccine records. I also understand that if proof of rabies vaccination can not be provided that a rabies vaccine will be done prior to any additional services. *

I have read and understand.

Do you give Abri Vet Hospital permission to take photos and share those photos on social media or other various marketing materials? *

I give permission
I do not give permission

Signature *

Date *

Ready for a Visit?

Book an appointment today. We look forward to seeing you!

Book Appointment

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Location

1449 Trade Mart Blvd.
Winston-Salem, NC 27127

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Contact

Phone: 336-785-9228
Fax: 336-785-3154
Email: [email protected]
[email protected]

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Hours

Mon – Fri: 7:30 AM–1:00 PM &
2:00 PM – 6:00 PM
Sat – Sun: Closed

Have a Question?

It is our mission to partner with our clients to nurture and preserve the human-animal bond by providing compassionate, expert, and affordable veterinary care from your pet’s first adventure throughout a long and healthy life.

Name *

First

Last

Email *

Phone

How can we help you? *