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About
- Our Team
- Payment Options
Services
Resources
Contact Us

About
- Our Team
- Payment Options
Services
Resources
Contact Us

Schedule Appointment
Online Pharmacy
Payments

Our
App

New Client
Request Refill
Pay Bill Now

Request Appointment
Online Pharmacy
Payments

Our
App

About
- Our Team
- Payment Options
Services
Resources
Contact Us

About
- Our Team
- Payment Options
Services
Resources
Contact Us

Mon – Fri: 7 AM – 6 PM
Sat – Sun: Closed

(320) 252-6700

2703 Clearwater Road
St. Cloud , MN 56301

Mon – Fri: 7 AM – 6 PM
Sat – Sun: Closed

(320) 252-6700

2703 Clearwater Road
St. Cloud , MN 56301

New Client Check In

A New Client Of Companions Animal Hospital!

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.

“*” indicates required fields

Name(Required)

First Name Last Name

Spouse of Partner

First Name Last Name

Children's Names/Ages

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email Address(Required)

Enter Email Confirm Email

Home Phone(Required)

Cell Phone(Required)

May we text you (reminders/prescriptions are ready, ect.)?

Work Phone Number

Place of Employment

May we contact you at work?

Best time/phone # to call regarding your pet's care:

Spouse/Partner Work Phone

Spouse/Partner Place of Employment

May we contact your spouse/partner at work?

Emergency Contact Name

First Name Last Name

Emergency Contact Phone #

How Did You Hear About Us?(Required)

Please Specify(Required)

Promotion Code(Required)

Why did you decide to come here?(Required)

AAHA Accreditation! Ask us if you don't know about AAHA

Day Care Services

Grooming Services

Convenient Location

Referral/Reputation in the community

Lodging Facilities for dogs, cats (separate!)

Person who answered the phone was friendly/competent

Laser Surgery available

Pain Management Services-Therapy laser, massage...

Veterinary Care for Exotic Pets (rabbits, guinea pigs, ferrets)

How do you view your pet(s) in terms of overall health concerns/issues?

As a family member (I am concerned about all health issues and recommendations)

As a pet (only concerned with basic health care such as exam and vaccinations)

Pet's Name(Required)

Age: Years, Months

Type of Pet(Required)

Where did you get your pet?

How long have you owned your pet?

What prior illness or health issues has your pet had?

How often do you bathe your pet?

How often do you brush/comb your pet?

What type of exercise does your pet receive, and how often?

How often is your pet around other animals (other than your own)?

How much time does your pet spend outside?

Which wildlife is in your area? (Choose all that apply) *

Rabbits

Squirrels

Skunks

Raccoons

Deer

None

Does your pet go to: (Choose all that apply) *

Groomer

Boarding

Pet Shows

Pet Stores

None of the above

Do you travel with your pet? If so, where else has your pet been?

Does anyone in your household smoke?(Required)

Yes

No

Is your pet on pet insurance

Yes

No

Is Your pet Spayed or Neutered?(Required)

Yes

No

If you chose NO for the previous questions, do you plan to have it done?

Yes

No

Do you plan to breed your pet?(Required)

Yes

No

Does your pet have any known drug reactions?

Yes

No

Do you have a UVB light for your pet?

Yes

No

If yes to previous question, what type?

Do you have a thermometer in the cage/area?

Yes

No

If yes to previous question, what type?

Do you have a humidity monitor in the cage/area?

Yes

No

If yes to previous question, what type?

Does your pet have any drug or vaccine reactions?(Required)

Yes

No

Does your pet hunt?(Required)

Yes

No

Is your pet on a preventative for controlling external parasites? (fleas and ticks)(Required)

Yes

No

Is your pet on a preventative for controlling internal parasites? (heartworm, roundworm, etc)(Required)

Yes

No

Has your pet been micro-chipped or tattooed?(Required)

Yes

No

Has your pet ever had professional dental care?(Required)

Yes

No

Do you understand the health benefits and life extending effects of providing proper dental care for?(Required)

Yes

No

Do you trim your pet's nails at home?(Required)

Yes

No

Would you like to learn how to trim your pet's nails?(Required)

Yes

No

Check any of the following that are of concern to you regarding your pet's behavior/health(Required)

Excessive Barking

House Training

Soiling/Spraying inside

Problems around children

Shedding

Anxiety

Jumping

Straying from home

Itching/scratching

Overly rambunctious

Biting

Clawing or digging

Bad breath

Destructive Behavior

None of the Above

Which of the following are services that you might utilize:(Required)

Lodging/boarding facility

Referral rewards program

Wellness plans

Massage therapy

Evening hours

Grooming

Day care

Product trials

In an emergency where you can not be immediately contacted, you want Companions Animal Hospital to:(Required)

Provide CPR

Do not resuscitate

Breed(Required)

Sex(Required)

Male

Female

Neutered/ Spayed

Neutered

Spayed

Neither

Pet's color/markings(Required)

Date of pet's last examination

Please list all other pets below. Please include sex, if they are altered, breed and age.

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?

Yes

No

Reasons of conditions that prompted your visit?

Special requests or conditions?

May we use your pet(s) picture(s) on our website and other materials (bulletin boards etc)?(Required)

Yes

No

Email

This field is for validation purposes and should be left unchanged.

Mon – Fri: 7 AM – 6 PM
Sat - Sun: Closed

Address:

2703 Clearwater Road
St. Cloud , MN 56301

Email:

clientcare@companionsweb.com

Phone:

(320) 252-6700

Hours:

Mon – Fri: 7 AM – 6 PM
Sat - Sun: Closed

Send Us a Message

"*" indicates required fields

Name*

Email*

Enter Email Confirm Email

Phone*

Message

How Did You Hear About Us?*

Please Specify*

Promotion Code*

Name

This field is for validation purposes and should be left unchanged.

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