New Client Form

Owner's Name*
First Last
Spouse/Co-Owner Name
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Secondary Phone
Email*
How did you hear about us?*
- Sign/Driveby
- Yellowpages
- Google Search
- Website
- Personal Recommendation
- Other
Who? So we can thank them!
Other
Do you have pet insurance?*
- Yes
- No
Which company?
Pet Information
Name*
Color/Description*
Breed*
Sex:*
- Male
- Female
- Neutered
- Spayed
DOB/Age*
Is your pet microchipped?*
- Yes
- No
Add another pet?*
- Yes
- No
Name*
Color/Description*
Breed*
Sex:*
- Male
- Female
- Neutered
- Spayed
DOB/Age*
Is your pet microchipped?*
- Yes
- No
Any allergies to vaccine or medications?*
- Yes
- No
Describe below
Any previous illnesses or surgeries?*
- Yes
- No
Describe below
Is your pet on any diet or special medication?*
- Yes
- No
Describe below
Previous veterinarian information:
All Fees Are Due At The Time Services Are Rendered. Please indicate choice of payment:
- Cash/Check
- Visa
- Mastercard
- Discover
- Care Credit
Make my pet a social media star! I authorize and grant Hometown Veterinary Hospital permission to take a picture of my pet and use it on Social Media (Facebook, Instagram, Twitter, etc.)*
- Yes!
- No, thank you
*
- Record release: Sometimes boarding facilities, groomers, refer ral hospitals, etc. may request records to be faxed. We are asking at this time for your consent to do so if requested.
I hereby authorize the veterinarian to examine, prescribe for, or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for treatment.*
(Sign here)

About Us

Hometown Veterinary Hospital is owned by Springfield natives Dr. Kara (Chappell) Amstutz and Dwight Amstutz. Our practice has continuously grown since it’s beginning in 2002 with each advancement focused to better serve our clients and their pets. We focus on being very transparent with our clients as we team with you to provide unparalleled care of your pets. Our motto says it all..Hometown Veterinary Hospital, Where Medicine and Mercy Meet.

Hours

Monday - Friday: 7am-5pm
(Thursdays closed 12pm-2pm for staff training)
Saturday: Closed
Sunday: Closed

After Hours Emergency

Emergency Veterinary Clinic of SW Missouri
400 S Glenstone Ave, Springfield, MO 65802
417-890-1600

Contact

(417) 208-5491
hometownvet@gmail.com

Location

2215 W. Republic Road
Springfield, Missouri 65807

Directions

Take Kansas Expressway South to Republic Road, turn right (west), we are at the 1st stop light on the northwest corner of Cox and Republic Road.