Northrock Hospital for Animals

(316) 636-1200

8338 East 29th Street North, Wichita, KS 67226

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New Client Registration Form

Northrock Hospital for Animals Patient/Client Information

Thank you for giving us the opportunity to care for your pet. Please help us better meet your needs by taking a few moments to fill out both sides of this information sheet.
Address(Required)
I give permission to NRHA and/or any business that represents them to contact me at the cellular number listed above if needed.(Required)
I give permission to NRHA and/or any business that represents them to post my pet's picture, video, story and medical information on social media.(Required)
We will gladly prepare a written estimate if you so desire. Please ask a receptionist or doctor. Professional fees are due at time services are rendered. If you wish to pay by check or credit card, please complete the following.
How did you hear of our hospital?(Required)
To help prevent the spread of infectious diseases, ALL hospitalized and boarded animals must be current on all vaccines.

I understand every effort will be made to achieve a successful outcome and to provide for all possible safety in hospital care and handling. I hereby authorize this hospital to receive, prescribe for, treat or perform surgery upon the pet(s) listed on the reverse side. Furthermore, I agree to pay fees for services rendered at the time the pet is discharged from the hospital or the service is otherwise terminated. I agree to pay for the reasonable costs of collection in the event that collection efforts become necessary. There will be a service charge for any check returned unpaid.
MM slash DD slash YYYY

Animal Medical History



Please complete information for all your pets - Thank You!

Pet #1

Please write down the dates the Vaccinations vaccines/tests were given.

DHLPP (Distemper/Parvo - Dogs)
Corona (Dogs)
Bordetella (Kennel Cough - Dogs)
Lyme (Dogs)
Rabies (Dogs/Cats)
FVRCP (Distemper - Cats)
FELV (Feline Leukemia - Cats)
Other Vaccines - Please List
Heartworm Test (Dogs)
Heartworm Prevention? (Dogs)
Feline Leukemia/Feline Aids Test
Fecal Test (Stool Exam for Worms)
Dentistry (Date Work was Done)
Geriatric Health Screen
Food or Drug Allergies
Current Medications

Thank You

Testimonials

The staff was incredibly friendly and worked with me to help my new dog get a last-minute rabies shot! Lovely people and lovely place! Highly... read more

Eriq G.

I have been bringing my fur baby to Northrock Hospital For Animals for over a year now, and I have never been disappointed. They are always so kind... read more

Sarahi A.

I had a great experience here. I took my dog to VESH because he had fairly bad swelling on his muzzle. It turned out to be an abscess under one of... read more

A B.

Eriq G.

The staff was incredibly friendly and worked with me to help my new dog get a last-minute rabies shot! Lovely people and lovely place! Highly recommend!

Sarahi A.

I have been bringing my fur baby to Northrock Hospital For Animals for over a year now, and I have never been disappointed. They are always so kind and caring when we come in. I recently adopted another fur baby and she was welcomed with as much love as my first fur baby.

A B.

I had a great experience here. I took my dog to VESH because he had fairly bad swelling on his muzzle. It turned out to be an abscess under one of his teeth. The emergency vet didn’t have any oral surgery openings for 3 weeks. The regular vet I was seeing at the time also had no openings for about 2 weeks. I was recommended to north rock by VESH because of the situation. I called first thing in the morning and they fit him in immediately! So happy with them they did me and my baby a huge favor with their urgency. I ended up taking my other dog in a week or two later to do a teeth cleaning as well. Great experiences both times. Plus I don’t think it’s was crazy expensive either. Not low end necessarily but for the care you receive its amazing.

Our Location

Northrock Hospital for Animals

8338 East 29th Street North
Wichita, KS 67226

(316) 636-1200

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