Please review our No-Show Policy before your appointment.

Note to Large Animal Clients.

New Client Form

Name: Animal Hospital of Tiffin
Address: 2765 S State Route 100, Tiffin, OH, 44883, United States
Telephone: 419-455-0470
Price range: $

We are so excited to welcome you to our family!

get started

Thank you for choosing us!

Thank you for choosing the Animal Hospital of Tiffin to be your preferred Tiffin, OH, veterinarian. We look forward to meeting you and building a bond with you and your pet!

New Client Form

Please fill out the following form as thoroughly as possible. If you have any questions, call us. Please Note: All * fields are required.

Owner Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Employer/Business

Employer/Business Address

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone *

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

Do you have pet insurace? *

What is the name of your insurance company? *

Pet Information

Pet's Name *

Species *

Dog
Cat
Other

If 'Other', please specify: *

Breed *

Coat Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Please list any known vaccines your pet has received and the dates they were last given:

This includes Rabies, Feline/K9 Distemper, Bordetella, Lyme, Lepto, and FeLV.

Please list any previous major health problems:

Please list any known drug or vaccine reactions:

Is your dog on heartworm prevention?

Date of Last Heartworm Test

Would you like to add another pet?

Second Pet Information

Pet's Name *

Species *

Dog
Cat
Other

If 'Other', please specify: *

Breed *

Coat Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Please list any known vaccines your pet has received and the dates they were last given:

This includes Rabies, Feline/K9 Distemper, Bordetella, Lyme, Lepto, and FeLV.

Please list any previous major health problems:

Please list any known drug or vaccine reactions:

Is your dog on heartworm prevention?

Date of Last Heartworm Test

Would you like to add a another pet?

Third Pet Information

Pet's Name *

Species *

Dog
Cat
Other

If 'Other', please specify: *

Breed *

Coat Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Please list any known vaccines your pet has received and the dates they were last given:

This includes Rabies, Feline/K9 Distemper, Bordetella, Lyme, Lepto, and FeLV.

Please list any previous major health problems:

Please list any known drug or vaccine reactions:

Is your dog on heartworm prevention?

Date of Last Heartworm Test

Authorization

Please provide an image of your photo ID below (Red Flag Law):

Click or drag a file to this area to upload.

How will you pay for today's visit?

Cash
Credit/Debit Card (Master Card, VISA, Discover, American Express)

We also offer a payment plan called CareCredit that allows you to start treatment today and spread payment over time. Applying for CareCredit only takes a few minutes and there is NO fee to apply. Call 1-800-365-8295. Must be 21 years or older to apply by phone. You can also apply at CareCredit.com.

The above information is accurate and true to the best of my knowledge, and I hereby authorize the veterinarian to examine, prescribe for, or treat the above-described pet(s). *

I have read and agree with the above statement.

I authorize the Animal Hospital of Tiffin to use photographs or videos of my pet(s) for educational or promotional purposes in any type of media, including its website(s). The photographs or videos may not be used for profit without my express permission. *

Yes, you may use my pet's images.
No, you may not use my pet's images.

Please upload any relevant files or information below:

Click or drag a file to this area to upload.

I assume responsibility for all charges incurred in the care of this animal and that these charges will be paid in full at the time of release. I understand that a credit card number (with an expiration date) and deposit will be required for surgical treatment for major procedures. In the event of payment decline, I will pay reasonable attorney's fees and costs of collection. If payment becomes 30 days past due, service charges add a fee of 2% per month (24% per annum), and a $10.00/month billing fee will be added to the balance due. WE RESERVE THE RIGHT TO TAKE LEGAL ACTION ON ANY UNPAID BALANCE. *

I have read and accepted the above statement.

Signature *

Date *

Website

Get In Touch



Call: 419-455-0470



[email protected]



2765 S State Route 100, Tiffin, OH 44883



Monday - Friday: 8 AM - 5:30 PM

Saturday: Closed

Sunday: Closed

Book an Appointment

We will do our best to accommodate your busy schedule. Book an appointment with us today by giving us a call or using our online booking!

Book Appointment

Questions?

Leave us a message below. We look forward to hearing from you!

Name *

First

Last

Email *

Phone

How can we help you? *

Name

Proudly serving Tiffin, OH and beyond.

If you are looking for a caring and compassionate animal hospital to take care of your pet, look no further than the Animal Hospital of Tiffin. Come see us today!