Name: Gentle Doctor Animal Hospital
Address: 3079 State Hwy K, O'Fallon, MO, 63368, US
Telephone: (636) 272-5950

Is your pet a new patient at Gentle Doctor Animal Hospital? Please fill out our New Patient Form at least 24 hours before their first appointment, and indicate whether your pet's veterinary and vaccine records are attached or are being sent by your previous vet^*.

New Patient Form

*Please note: This form and your pet's records must be received by Gentle Doctor Animal Hospital 24 hours prior to your pet's appointment to keep your scheduled time with the veterinarian. Please feel free to call us with any questions you may have.

Owner Information

Owner First Name *

Owner Last Name *

Secondary Owner / Authorized Agent Name

Email Address *

Mobile Phone *

Secondary Phone

Work Phone

Address *

City *

State *

Zip Code *

Employer

Occupation

Date of Birth *

How did you hear about us? *

Primary Care Veterinarian

Internet

Friend / Family

Community Event

Signage

Printed Publication

Radio

QR Code

Other

Emergency Contact

Primary Emergency Contact Name *

Primary Emergency Contact Phone *

Secondary Emergency Contact Name *

Secondary Emergency Contact Phone *

Do you authorize your emergency contact(s) to make urgent treatment decisions if you are unreachable? *

Yes

Do you authorize your emergency contact(s) to receive patient information in addition to your primary care veterinarians? *

Yes

Patient Information

Pet Name *

Birth Date / Age *

Species *

Breed / Other Species *

Color

Gender *

Spayed or Neutered? *

Presenting problem, special needs, concerns *

Veterinary & Vaccine Records

Vaccination Status *

Agreement with Veterinary & Vaccine Records Policy *

I acknowledge that my pet's records are required at least 24 hours prior to my appointment. If I do not have my pet's records available 24 hours prior to my appointment, I understand that the check-in process will be delayed and may result in an extended appointment time and/or a cancellation of appointment if Gentle Doctor Animal Hospital is unable to provide later appointment availability. These records are attached below.

Please indicate whether you or your vet will be submitting your pet's Veterinary & Vaccine Records *

If you are submitting your pet's Veterinary & Vaccine Records, please upload them below

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Primary Veterinarian Information

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Gentle Doctor Animal Hospital to release patient information to the primary care hospital or veterinarian.

Primary Care Facility

Primary Care Veterinarian(s)

Photo Consent: By checking ‘YES’, I consent and authorize Gentle Doctor Animal Hospital to use pictures of my present pet(s) and all future pets for purposes of social media posts, hospital website/brochures or for educational purposes. I understand that once my consent is given, it will remain in effect until I provide written revocation of consent. *

Yes

Medical Record Release: I hereby give permission to the employees of Gentle Doctor Animal Hospital to provide health records as needed to outside services including, but not limited to: Boarding kennels, Groomers, Animal Control, Veterinary Emergency Centers and Specialty Veterinarian Hospitals as they deem appropriate and necessary. *

Yes

By submitting this form, I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to the discharge of patient from Gentle Doctor Animal Hospital

Agreement with Cancellation Policy *

I acknowledge that if I am unable to attend my scheduled appointment, I am required to give 24 hours notice of cancellation and/or request to reschedule.

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Happy Tails From Clients

We've been taking our dogs to Dr. Julie for years and couldn't be more impressed with her professionalism and kindness, as well as the entire staff at GD, always a pleasure when visiting the office. Even during the pandemic, their curbside service was much appreciated. They've taken great care of our fur babies and the cost to do so is affordable. Highly recommend to anyone with pets!
Mary G.

New Patients Welcome

Gentle Doctor Animal Hospital is accepting new patients! Our experienced vets are passionate about the health of companion animals in O’Fallon and surrounding communities. Get in touch today to book your pet's first appointment.

Location

Gentle Doctor Animal Hospital

3079 State Hwy K O'Fallon MO 63368 US

Contact

Call (636) 272-5950
Send an email

Hours

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- Monday:07:30 am - 06:00 pm
- Tuesday:07:30 am - 06:00 pm
- Wednesday:07:30 am - 06:00 pm
- Thursday:07:30 am - 06:00 pm
- Friday:07:30 am - 06:00 pm
- Saturday:08:00 am - 01:00 pm
- Sunday:Closed