Pre-Register for Care

Please fill out the form to pre-register for care at our urgent care clinic in West Columbia, SC.

Company
This field is for validation purposes and should be left unchanged.
Pet Registration for CVETS Urgent Care
2989 Sunset Blvd West Columbia, SC 29169
Owner Name*
First Last
Co-Owner Name (If applicable)
First Last
Primary Phone*
SMS Text Agreement
I agree to receive text updates and reminders.
By checking this box, I agree to receive SMS/text messages from CVETS to the mobile number provided above. I understand I am not required to provide consent for texting as a condition of treatment. Reply STOP to cancel. Message and data rates may apply.
Additional Phone Number
Email*
Address*
No PO boxes per DEA guidelines.
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Are you active or retired military, law enforcement, or veterinary professional?*
- Yes, Military
- Yes, Law Enforcement
- Yes, Veterinary Professional
- No
I consent to my pet’s image to be used for marketing purposes, ie social media, print material, website photos, etc.*
- Yes
- No
Payment Policy & Treatment Consent*
I agree to the privacy policy and treatment consent.
I understand and agree to authorize the veterinarian to examine, prescribe for and provide initial diagnostics for my pet. I am aware a deposit may be required prior to work up. All accounts must be paid at time of discharge. I am 18 years old or older and am accepting financial responsibility for this patient’s medical care and assume responsibility for all fees associated with the collection of any unpaid balance.
Pet Name*
Date of Birth or Approximate Age*
Spayed/Neutered/Intact*
Species*
Breed*
Color*
Primary Veterinarian Practice Name*
If you do not have a primary veterinarian, write none or n/a
Primary Veterinarian Name*
If you do not have a primary veterinarian, write none or n/a
Reason For Visit*
Please list all medications that your pet is currently on, including herbs and/or supplements below, as well as their last dosage.*

Pre-Register for Care

Pet Registration for CVETS Urgent Care