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(502) 499-6535
6902 Bardstown Rd, Louisville, KY 40291
M-T-Th-S: 7am - 6pm | W: 7am - 6pm | Fri: 9am - 6pm | Sun: Closed
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HOME
ABOUT
Veterinarians
Employment
Our History
What is AAHA
Why Choose Us?
SERVICES
Wellness and Preventative Medicine
Full Service Pet Care
Puppy and Kitten Care
Adult Dog & Cat Care
Senior Dog & Cat Care
Nutritional Counseling
Certified Low Stress Patient Handling
Diagnostic Services
Diagnostic Laboratory Testing
Digital Radiology
Electrocardiography Testing
Blood Pressure Testing
Pet Dermatology
Eye Care
Surgery
Routine Surgery
Emergency Surgery
Electrocautery Surgery
Spay and Neuter Surgery
Pet Dental Care
Preventative Dental Care
Advanced Dental Care
Pain Management
Laser Therapy
Pet Pharmacy
On-Site Pharmacy
Online Pharmacy
Health Services for Travel
Hospitalization
End of Life Care for Pets
RESOURCES
Lifelearn Pet Library
AVMF Donation
Online Reviews
End of Life Care for Pets
Pet Help Videos
Disaster Guidelines
Hospital Tour
Pet Insurance
CareCredit Medical Credit Card
Puppy Care Articles
Kitten Care Articles
Flea, Tick, Heartworm Chart
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Marked fields are required [*]
Owner Information
Name
*
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Last
Address
*
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Address Line 2
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*
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*
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Pet Information
Pet Name:
*
Sex
*
Male
Female
Spay / Neuter
*
Yes
No
Age:
*
Date of Birth:
Species
*
Dog
Cat
Breed
*
Color
*
Length of time owned pet:
*
Adopted pet from:
Or found pet:
Regular Veterinarian
Clinic
Last visit date:
Reason
Vaccine History:
*
Current medications:
Flea Product:
*
Date Given:
*
Heartworm Preventative:
*
Date given:
*
Brand of food:
*
Current appetite:
*
Habitat:
*
Indoor
Outdoor
Both
Travels:
*
Yes
No
Exposure to wooded areas
*
Yes
No
Is your pet microchipped?
*
Yes
No
Do you, any household family members or your pet have any allergies to peanuts, latex, etc?
*
Yes
No
Explain
*
Previous illness or surgery:
*
Do you already have an appointment scheduled?
*
Yes
No
If you answered Yes above, when is your appointment scheduled for?
MM slash DD slash YYYY
Main concern this visit:
*
How did you hear of our hospital?
How did you hear of our hospital?
*
Referral from friend/co-worker/or family member
Referral from regular vet
Outside sign
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Other
Who shall we thank?
*
Other:
*
Responsible Owner Agreement and Medical Information Release Authorization
I agree and understand that it is the policy of this hospital to receive payment as services are rendered and that a deposit will be required upon admission to this hospital for patient treatment. I state that I am over 18 years of age, and I am the responsible owner of this pet and represent any and all other owners. I also give Jefferson Animal Hospital permission to share any and all information in my pet(s) medical record with my regular veterinarian. Additionally, I give my regular veterinarian permission to share my pet(s) medical record with Jefferson Animal Hospital. I give the staff and management of Jefferson Animal Hospitals permission to use my own or my pet(s) photo for promotional purposes as they see fit. I understand that I will not be compensated for allowing the hospital to use my pet’s name and likeness, or my own or my family’s likeness.
*
I agree and understand [REQUIRED]
Your DOB:
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Drivers Lic. #
*
Co-Owner DOB:
Co-Owner Drivers Lic#
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