South Texas Veterinary Urgent Care

Contact Information

Are you a current client?(Required)

Yes

Primary Contact Name(Required)

Primary Contact Phone Number(Required)

Primary Contact Email Address(Required)

Secondary Contact Name

Secondary Contact Phone Number

Address(Required)

City(Required)

STATE(Required)

Zip Code(Required)

This field is hidden when viewing the form

Preferred Method of Contact(Required)

Phone Call

Text / SMS

Pet Information

Patient's Name(Required)

Date of Birth / Estimated Age(Required)

Breed(Required)

Spayed/Neutered(Required)

Yes

Gender(Required)

Female

Male

Pet Information - below please indicate your primary concern for today's visit: (i.e vomiting/diarrhea/ lameness)(Required)

About Us

How did you hear about us?

Bench/Local ad

Family/Friend (please indicate below)

Facebook/Instagram/Social Media

Internet search

Primary Veterinarian

The Cattery

Healthy Start Certificate: The Cattery

Other (please indicate below)

Family/Friend

Other

Do you currently use a primary care veterinarian, specialty vets, or have any other affiliations you'd like us to know about?

Photograph and Video Release: There may be times we would like to share a photo or video of your pet with our social media sites (including but not limited to our website, Facebook, Instagram, etc.) Please indicate your wishes below:(Required)

I hereby grant permission to use my pet(s) photograph or video on social media, website, promotional materials, etc, without compensation. Materials will become the property of the hospital.

I decline the use of my pet(s) photograph or video on any social media, website, promotional materials, etc.

Notification Settings - We use text messages and email to communicate appointment reminders, as well as your pet's health reminders (vaccines, exams, etc), and occasional emergency closure notices. If you would like to opt OUT of these reminders, please indicate below.

I consent to text and email notifications at the above primary cell number and email.

I consent to email notifications ONLY.

I consent to text notifications ONLY. I am aware I will not receive my pet's reminders and will need to use the PetPortal to see when they are due for services.

I decline both email and text notifications. I am aware I will not receive my pet's reminders and will need to PetPortal to see when they are due for services..

Consent for Audio Recording (Medical Documentation)

Purpose of Recording

To support accurate and complete medical documentation, our practice may use secure audio recording during your visit. These recordings are used solely to assist a medical scribe or approved documentation technology in creating your medical notes.

Privacy & Security

Recordings are used only for documentation purposes
They are stored securely and handled in accordance with applicable privacy laws
Recordings are not used for training, marketing, or any other purpose
Recordings are deleted according to our record-retention policy after documentation is completed

Your Choice

Your consent is voluntary. You may decline audio recording or withdraw your consent at any time by informing your provider. Declining will not affect the quality of care you receive.

I consent to the audio recording of my visit for the purpose of medical documentation as described above.

I, , the undersigned, am the owner or agent for the owner of the animal(s) described, and I have the full and exclusive authority to execute this consent.

I certify that I am 18 years of age or older.
I give permission to doctors, staff, authorized agents, or representatives of this hospital to examine, prescribe for, and treat my pets.
I agree to pay for all services rendered and medications, goods, and supplies when purchased.
I understand that all fees are due at the time services are rendered and the hospital accepts cash, and all major credit cards.
I understand that a deposit may be required for surgical or medical treatment.
I understand that if my pet ever requires overnight hospitalization, there will not be overnight supervision provided.
I release this hospital from any and all liabilities.
By my signature below, I hereby acknowledge that I agree to all of the above and acknowledge the receipt of a copy of this agreement upon request.

Owner/Agent Name

February 14, 2026

Signature