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New Clients

If you are a new client with and would like to Make An Appointment, please complete our online booking form or contact us at 414-744-2240.

Welcome and thank you for choosing St. Francis Animal Hospital! We are dedicated to maintaining the health of your pet and look forward to many future years together. Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s).

Owner's Name(Required)

Owner's Birthday(Required)

Address(Required)

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Phone Number(Required)

Email(Required)

Co-Owner Name

Co-Owner Phone Number

Other Authorized Person(s) you would like to add to your chart (must be at least 18 years old)

Name

Phone

Name

Phone

Please answer the following questions:

Where did you go for previous veterinarian care

May we release your records to any third party?(Required)

Yes

No, I wish to be contacted first.

Note: A third party may be a groomer, doggy daycare facility, other animal hospitals/referral centers or rescues.

Are you a senior citizen? (65 or older)(Required)

Yes

No

Are you active duty or retired military, active police officer or firefighter?(Required)

Yes

No

Photo Consent: We love to take photos of our patients for educational purposes, marketing, social media, our website and medical charting reasons. No personal information will be used without your permission. Do you consent to allowing us to take and/or use photos of your pet for the above described purposes?(Required)

Yes

No

Authorization for treatment:
I hereby authorize the veterinarian(s) of St. Francis Animal Hospital to examine, prescribe, treat and perform procedures for my pets as medically deemed necessary and authorized by me. I understand that I am responsible for all costs incurred and that payment is due at the time of service. I further acknowledge that no guarantee has been made as to the results that may be obtained. I understand that complications may arise which cannot be predicted and that I will be held financially responsible for any veterinary medical care necessitated by complications.

Signature(Required)

Date(Required)

New Clients

Get in touch

414-744-2240

Business Hours

414-744-2240