614-389-6455 info@shawneehillsvet.com

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Name*

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Email*

Address*

Address Line 1 Address Line 2 City State ZIP Code

What county do you live in?*

Delaware

Franklin

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Other

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Primary Phone*

Secondary Phone

Emergency Contact*

First Last

Emergency Contact Phone*

How did you find out about our hospital? If you were referred by someone, who should we thank?*

Preferred way of being contacted by our staff about your pet's care?*

Text Message

Phone

Email

Appointment/vaccine reminders will be sent via email, or postcard if no email provided.

May we use your pet’s photo on our social networking sites?*

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No

Pet's Name*

Age/Date of Birth*

MM slash DD slash YYYY

Species (dog, cat, etc.)*

Color*

Breed*

Does your pet have a microchip identification?*

Yes

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What is the microchip number?*

Do you have pet insurance?*

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If yes, who is your insurance provider?*

Policy number:*

Sex*

Male

Neutered Male

Female

Spayed Female

Do you have any other pets at home?

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Cats

Pocket Pets

Other

Please use this area to describe your additional pets(name, age, color, breed, gender, pet insurance):

Full payment is required at the time services are provided (we are not able to provide billing services). We accept Visa, MasterCard, Discover Card, Care Credit, American Express, Cash and Check (with driver’s license) payments. All returned checks will result in a $25 returned check fee. I understand that the hospital staff will provide an estimate of current and anticipated charges before services are rendered. By signing below, I am requesting that veterinary care be provided for pets presented by me or my agents. I understand that I am financially responsible for all services provided.*

I have read and accept the financial policy.

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Find us on PetDesk!

Our hospital is nestled in the village of Shawnee Hills, conveniently located by Dublin. AHSH proudly serves the pets of Powell, Dublin, Plain City, Ostrander, Northwest Columbus, and surrounding areas. Easily request an appointment for your pet using our online system on PetDesk and keep up with your pet’s health by downloading our app!

Visit Animal Hospital of Shawnee Hills

& Download Our App!

Our hospital is nestled in the village of Shawnee Hills, conveniently located by Dublin. AHSH proudly serves the pets of Powell, Dublin, Plain City, Ostrander, Northwest Columbus, and surrounding areas. Easily request an appointment for your pet using our online system on PetDesk and keep up with your pet’s health by downloading our app!