New Client Form

Name: Abri Veterinary Hospital
Address: 1449 Trade Mart Blvd., Winston-Salem, NC, 27127, United States
Telephone: 336-785-9228
Price range: $

CALL US

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 *

Canine
Feline

Breed *

Color

Age/Date of Birth

Sex *

Male
Male (neutered)
Female
Female (spayed)

Is your pet microchipped? *

Is your pet allergic to any medications or vaccinations? *

If yes, please explain *

Is your pet currently taking any medications? *

If yes, please list all medications (name, dosage, and frequency) *

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 *

AAHA-accredited veterinary care in Winston-Salem, NC.

We go above and beyond for your pet. Our hospital is AAHA-accredited and offers a wide range of veterinary services, pet boarding, and grooming. We have everything your pet needs under one roof!

Contact Us

Get in Touch

[email protected]

Phone: 336-785-9228

Fax: 336-785-3154

1449 Trade Mart Blvd.
Winston-Salem, NC 27127

Hours

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

Keep up with us on Facebook

Walk-in information:

M-F, Before lunch:
Last walk-in accepted at 12:00 PM | Last appointment at 12:30 PM
M-F, After lunch:
Last walk-in accepted at 5:00 PM | Last appointment at 5:30 PM
Saturday:
Last walk-in accepted at 11:00 AM | Last appointment at 11:30 AM

Say Hello

Name *

First

Last

Email *

Phone

How can we help you? *

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

Download our app and connect with us on PetDesk!

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. Plus, you’ll be able to communicate with us much easier. You’ll be able to:

Request Appointments 24/7
Receive Automatic Reminders
Save Notes, Pics, and Much More
Your Pet’s Free Organizer App
Two-Way Texting With Our Team

Download App