Harrison, OH 45030


(513) 367-4806
harrisonanimalhospital@yahoo.com


Book Appointment

(513) 367-4806
harrisonanimalhospital@yahoo.com

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About Us
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Resources
- Payment Options
- Online Forms
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Online Pharmacy
Contact

Book Appointment

Home
About Us
Services
Resources
- Payment Options
- Online Forms
Careers
Online Pharmacy
Contact

New Client Form

Save time during your appointment! Complete your required forms online from any device at any time before your visit.

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pets before your visit.

OR

Click on the Download Form button below. Please print and complete the form and bring it to the hospital at the time of your appointment.

Date *

Client Information

Name (Last Name, First Name) *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone *

Cell Phone

Work Phone

Alternate Phone Number

How did you learn about our practice *

Email *

(We send patient vaccination reminders via e-mail)

Pet Information

If you have multiple pets, please feel welcome to fill out additional ‘pet information forms’.

Pet's Name *

Patient's Species *

Canine
Feline
Other

If other, please specify: *

Sex *

Male
Male (Neutered)
Female
Female (Spayed)

Pet’s Age

Pet’s Birthdate (If known)

Breed *

Color *

Is your pet currently using a flea and tick preventative? *

Yes
No

Is your pet taking a monthly heartworm preventative? *

Yes
No

Pet’s History (Check all that apply)

Please provide medical records to our receptionists so they can update your pet’s vaccination status.

Heartworm Test
Feline FELV/FIV Test
Microchip
Prior Surgery
Prior Illness
Other

Please provide microchip identification number to our receptionists. Thank you.

Heartworm Test: Date Last Performed

Heartworm Test: Results

Feline FELV/FIV Test: Date Last Performed

Feline FELV/FIV Test: Results

Please briefly explain any prior surgery:

Please briefly explain any prior illness:

If other, please briefly explain:

Authorization *

I hereby authorize the veterinarian to examine, prescribe for, and/or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of the animal(s). I also understand that COMPLETE PAYMENT IS REQUIRED WHEN SERVICES ARE RENDERED. We accept cash, credit cards, checks, and CareCredit. If you wish to pay by check, a copy of your driver’s license is required. Please provide this to our receptionists.

Signature of Owner/Responsible Agent *

Date *

Email

Ready to Visit?

Please give us a call at (513) 367-4806 to schedule an appointment for your pet today!

Book Appointment

Have a Question?

Get in touch! We look forward to hearing from you.



Address

102 May Dr. Harrison, OH 45030



Contact Information

Phone: (513) 367-4806
Fax: (513) 367-4946
Email: harrisonanimalhospital@yahoo.com



Hours

Monday-Friday: 8:00 am – 6:00 pm
Saturday: 9:00 am – 5:00 pm
Sunday: 10:00 am – 4:00 pm
(Emergencies Only)

Name *

First

Last

Email *

Phone

How can we help you? *

Website

We Proudly Serve the Pets of Harrison, OH, and Beyond

Cincinnati, OH
Lawrenceburg, IN
Batesville, IN
Brookville, IN
Rising Sun, IN

Hebron, KY
Florence, KY
Burlington, KY
Western Hills, OH
Hamilton, OH

We Proudly Serve the Pets of Harrison, OH, and Beyond

Cincinnati, OH
Lawrenceburg, IN
Batesville, IN
Brookville, IN
Rising Sun, IN
Hebron, KY
Florence, KY
Burlington, KY
Western Hills, OH
Hamilton, OH

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