Sewell Animal Hospital

638 S Main
McAlester, OK 74501

(918)423-5100

sewellanimalhospital.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 cooporation in letting us assist you.

New Client

Name & Email (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 understand that prior to treatment or boarding, a full explanation of the fees will be given by the veterinarian and/or staff in the care of my animal(s). In the event that I cannot be reached but my pet needs treatment, I authorize the doctor to use her medical judgment to best treat my pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid in full at the time of release. We will not use your information for marketing communications without your written authorization. I consent to the use of periodic appointment reminder phone calls, voice mail messages, postcards, email or letters.
I have read this statement and -
I Agree
I Disagree



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