Please select one of the following

I am an existing client
I am a new client

Name *

First

Last

Email *

We will use this modality to send pet records, some results, and some receipts.

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Employer

Co-Owner Name

First

Last

Co-Owner Email

Co-Owner Phone

Co-Owner Address

Address Line 1

Address Line 2

City

State

Zip Code

Co-Owner Employer

Authorized Caretaker

First

Last

Relation

Phone

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

Pet Information

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Weight *

Sex *

Male
Neutered Male
Female
Spayed Female

I consent *

I consent to allow any member of Creekside's team scan my pet for a microchip at the time of presentation. This is a painless and generally stress-free task.

Does your pet get anxious at the vet or groomer? *

Yes
No
I do not know

Has your pet ever had a reaction to vaccines or medications? *

Yes
No
I do not know

If yes, what? *

Permission to retrieve veterinary records from: *

Yes
No

If yes, where should we call? Please list all that apply *

Pet Insurance?

Yes
No

Name of provider: *

Would you like to add another pet? *

Yes
No

Second Pet Information

Pet's Name *

Species (dog, cat, etc) *

Breed *

Color *

Age/Dath of Birth *

Weight *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet get anxious at the vet or groomer? *

Yes
No

Has your pet ever had a reaction to vaccines or medications? *

Yes
No

If yes, what? *

Pet Insurance?

Yes
No

Name of provider: *

Would you like to add another pet? *

Yes
No

Third Pet Information

Pet's Name *

Species (dog, cat, etc) *

Breed *

Color *

Age/Date of Birth *

Weight *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet get anxious at the vet or groomer? *

Yes
No

Has your pet ever had a reaction to vaccines or medications? *

Yes
No

If yes, what? *

Pet Insurance?

Yes
No

Name of provider: *

Would you like to add another pet? *

Yes
No

Fourth Pet Information

Pet's Name *

Species (dog, cat, etc) *

Breed *

Color *

Age/Date of Birth *

Weight *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet get anxious at the vet or groomer? *

Yes
No

Has your pet ever had a reaction to vaccines or medications? *

Yes
No

If yes, what? *

Pet Insurance?

Yes
No

Name of provider: *

Hospital Information

In the event of an after-hours emergency we recommend you call VCSG on Broad Street in Chattanooga at 423-591 0270. You may also consider Animal Emergency & Specialty Center or RIVER. *

I have read and understand

We are eager to unveil payment plans called Creekside Care Plans. This is a convenient monthly payment plan for all your pet’s preventative/wellness needs. Are you interested in learning more?

I want to learn about savings!

Medications and pet foods can be shipped directly to you from our trusted suppliers. Sound convenient? To get help signing up, please check the box below.

I am interesting in getting medications and foods shipped to me.

We love to advertise by showing off our adorable patients. Do you give permission for us to use photos of your pets in marketing materials (such as billboards, social media, pamphlets, photos in frames in our hospital)? *

Yes
No

Terms of Service

Payment in full is required at the time services are rendered. We accept Creekside Care Plans (Payment Plans), all major Credit Cards, Cash, and Care Credit. We do not accept checks. We appreciate you entrusting us with the care of your pet. We understand that having a sick pet is often an emotional time. The best veterinary-client relationships are based on trust, communication and mutual respect. We want what is best for your pet! We will treat you with kindness and ask that you do the same for our team. We have a zero tolerance policy for bullying, cyberbullying, defamation, aggressive tones or threats, unprofessional behavior, sexual harassment, homophobic behavior, racism, and animal abuse. We reserve the right to deny services due to client behavior at any time. Should it be necessary, we will happily provide your medical records to you so that you may continue your pet's care elsewhere. *

I have read and agree to your Terms of Service & Payment Policy

Click to learn more about Creekside Care Plans.

All information I have provided here is true to the best of my knowledge. I have read and understand the Terms of Service. *

Signature of Owner or Authorized Agent

Date *

Creekside Veterinary Hospital uses email often to communicate. The email address you filled out above will be used unless you otherwise specify. Please take the time now to add us to your address book so that our emails (which usually contain important information such as doctor notes, discharge instructions, etc) do not get funneled to your spam folder! Our email addresses are [email protected] and [email protected]. Thank you so much for your help! *

I will add [email protected] and [email protected] to the address book of the email address I've given above.

When you submit this form, we will enter your information into our records system. Please call, email, or use the portal to request an appointment. Thank you!

Please hit the submit button to ensure your entry gets submitted. You will be prompt to a success page if it has been submitted correctly.

Online Forms

New Client/ new pet Form

New Client Registration Form

Pet Information

Second Pet Information

Third Pet Information

Fourth Pet Information

Hospital Information

Terms of Service

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