New Client Information

Welcome to Guardian Animal Medical Center!

Complete the form below so our team can get to know you and your pet before your appointment. If you need immediate assistance, please call or text us at 606-928-6566.

Home Phone # *

Is your number unlisted? *

Email *

Owner's Name *

First

Last

Spouse/Other Owner

First

Last

Human Children (First Name & Ages)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Employer's Name

Spouse/Other Employer

Work Phone

Spouse/Other Work Phone

Cell Phone

Spouse/Other Cell Phone

At what time is it best to call about your pet? *

In case of emergency, please contact:

Emergency Contact Name *

First

Last

Emergency Contact Number *

We will gladly prepare a written estimate, if you desire. Please ask the receptionist or the doctor. If you have a budget/limit for today's visit, please let us know so we can help prioritize your pet's care. We accept credit cards and cash. We may need copies of your driver's license and account information depending on which payment method you select. PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED!

We consider our pet(s) *

Part of the Family
Just as pets

Would you like your name to be added to our mailing list? *

Regarding posting on social media *

It is okay to use my pet's image on social media
DO NOT release any image of my pet

TO PREVENT THE SPREAD OF INFECTIOUS DISEASE AND PARASITES, HOSPITALIZED AND BOARDED ANIMALS MUST BE CURRENT ON ALL VACCINES AND FREE OF INTERNAL AND EXTERNAL PARASITES *

If my animal is hospitalized or boarded, I authorize the doctor to provide vaccines and parasite control as needed for my pet.

(Without your signature, we cannot treat your pet at our hospital.)

Signature *

Clear Signature

(Without your signature, we cannot treat your pet at our hospital.)

Comments:

Animal Medical History

(Please complete all information for each pet you'd like to include on your account)

Pet's Name

Species *

Dog
Cat
Other

Pet's Breed

Color(s)

Age/Date of Birth

Length of time owned

Diet (Brand or type of food)

Vitamins (if any)

Types of Grooming Products

Hours spent outside in a day

Rabies (dog, cat, ferret)

Other vaccines (ferret distemper/lyme/bord/FIP)

Heartworm test date (dogs/ferret)

Heartworm preventive (dogs/ferret)

Fecal exam (stool check for worms)

Dentistry (all critters)

Prior Illness (all critters)

Prior Surgeries (all critters)

Would you like to add information for an additional pet? *

THANKS for choosing GAMC to help care for your pet!

We’ll be there when you need us.

Our Location

918 Bellefonte Road
Flatwoods, KY 41139
Click here for directions.

Our Hours

Mon, Tues, Fri: 8:00AM – 6:00 PM
Wed: 8:00AM – 2:00PM
Thur: 8:00AM – 7:00PM
Sat: 8:00AM – 12:00PM
We will be closed on some Saturdays. Please contact us to confirm our hours.

Contact Information

Call/Text: 606-928-6566
E: GuardianAppt@gmail.com
Tri State Animal ER: 304-453-5700