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Urgent Care

Home
About
Services
Resources
- Client Forms
- Client Education
Urgent Care

New Client Form

Thank you for giving James Island Veterinary Hospital the opportunity to care for your pets. We’re happy to answer any questions you may have regarding your pet’s health.

In order to ensure the best care possible, please take the time to fill out this registration form.

No Call-No show Policy: In the event you do not show up for your scheduled appointment, you will be considered a no call-no show. You are then required to pre-pay for your next exam to reschedule.

Owner's Name*
First Last
Address*
Street Address Address Line 2 City SC ZIP / Postal Code Country
Email Address*
- Check here if you would like email reminders.
Primary Phone Number*
Secondary Phone Number*
Emergency Contact Name*
First Last
Emergency Contact Phone Number*
How did you hear about us? (If referred by friends or family please let us know whom to thank)
Pet Name*
Species*
- Canine
- Feline
Sex*
- Neutered Male
- Spayed Female
- Intact Male
- Intact Female
Breed*
Color*
DOB*
Current Medications*
Current Diet*
Add another pet?
- Yes
- No
Pet Name*
Species*
- Canine
- Feline
Sex*
- Neutered Male
- Spayed Female
- Intact Male
- Intact Female
Breed*
Color*
DOB*
Current Medications*
Current Diet*
Add another pet?
- Yes
- No
Pet Name*
Species*
- Canine
- Feline
Sex*
- Neutered Male
- Spayed Female
- Intact Male
- Intact Female
Breed*
Color*
DOB*
Current Medications*
Current Diet*
Add another pet?
- Yes
- No
Pet Name*
Species*
- Canine
- Feline
Sex*
- Neutered Male
- Spayed Female
- Intact Male
- Intact Female
Breed*
Color*
DOB*
Current Medications*
Current Diet*
Add another pet?
- Yes
- No
Pet Name*
Species*
- Canine
- Feline
Sex*
- Neutered Male
- Spayed Female
- Intact Male
- Intact Female
Breed*
Color*
DOB*
Current Medications*
Current Diet*
Previous Veterinarian*
Previous Veterinarian Phone Number*
*
- By clicking this box, I do hereby grant permission to release any or all of the information contained in the medical records of my pets listed below to James Island Veterinary Hospital
ACKNOWLEDGEMENT OF PAYMENT UPON RECEIPT OF SERVICES: I hereby authorize JIVH’s veterinarians and support staff to examine, prescribe for, and/or treat the above named pet(s). I assume financial responsibility for all charges incurred in the care of my pet(s). I also understand that payment in full is due when services are rendered.
Signature*
Date*
MM slash DD slash YYYY
VETERINARY MEDICAL RECORDS RELEASE: I, the undersigned, do hereby grant my permission to release any or all of the information contained in the medical records of those pets listed below to the following person and/or veterinary practice.*
- Yes
- No
Initial*
I authorize JIVH to photograph my pet(s) and exhibit pictures in the clinic’s reception area, on social media networks such as Facebook, and/or on our website.*
- Yes
- No
Initlal*
Signature*
Date*
MM slash DD slash YYYY
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Come visit us today at

756 Folly Rd.
Charleston, SC 29412

756 Folly Rd.
Charleston, SC 29412

Hours
Monday: 7 am - 10 pm
Tueday: 7 am - 10 pm
Wednesday: 7 am - 10 pm
Thursday: 7 am - 10 pm
Friday: 7 am - 10 pm
Saturday: 7 am - 10 pm
Sunday: Closed

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