New Client Registration Form

12117 Manchaca Rd, Austin, TX 78748
512-VET-CARE / 512-838-2273

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Thank you for considering our hospital as your pet’s provider of veterinary services. 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). The required sections have a blue * asterisk.

Owner's Name
Name*
First Last
Street Address*
Address Line 2
City*
State*
Zipcode*
Day-Time Phone*
Evening Phone
Mobile Phone
Email*
Would you like us to send you appointment reminders via text message?*
- Yes
- No
Co-owner's Name & Contact #
Name
First Last
Phone
Email
How did you hear about us?
- Drive by/Sign
- Internet Search
- Facebook
- Instagram
- NextDoor
- Yelp
- Event (list which, below)
- Referral (please list who so we can thank them, below)
- Other (please list below)
Details
Pet #1 Info
Have more than one pet? Please complete the "Additional Pet Form" after this for each additional pet, or call us and we'll help.
Pet's Name*
Species*
Breed (if known)
Color
Date of Birth or Age (if known)
Special Identification (tattoo, microchip, etc.)
Sex
Previous Veterinary Practice (if any)
Previous Veterinarian (if any)
Date of last vaccines (if known)
Date Format: MM slash DD slash YYYY
What vaccines were given at this time
Is your pet on any medication or supplement?
- Yes
- No
If Yes, please list the medication or supplement
What food does your pet eat?
Does your pet have allergies or drug reactions?
- Yes
- No
If Yes, please list the allergies and reactions
Are there any current or past medical conditions of which we should be aware?
- Yes
- No
If Yes, please comment on the condition(s) and indicate if they are current or past conditions
Please use the following box to give us any other relevant information about your pet
Do you already have an appointment set up with us?*
- Yes
- No
If so, when?
What is the reason for your upcoming visit?

Ready to see our Vets? Request Appointment

Manchaca Village Veterinary Care

12117 Manchaca Rd.
Austin, TX 78748

Call 512-838-2273 (512-VET-CARE)
Text 512-838-2273
Email vet@manchacavet.com

Hours of Operation

Mon-Fri: 7:00AM-6:00PM
Saturday: 8:00AM-12:00PM
Sunday: Closed

(Hours subject to change temporarily during COVID-19 outbreak. Please call to confirm!)

Special Closures

Emergencies

During operating hours, call us at
512-VET-CARE (512-838-2273).

After-hours, please call the Emergency Hospital at: 512-899-0955.

Our Reviews

We are rated 4.8 out of 5.0 with over 250 reviews on Google alone! Click here to view.

Home
New Clients
About Us
Services
Resources
Pharmacy