New Client Form

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.

Pet Information

Pet's Name *

Species *

Canine
Feline

Breed

Color

Date of Birth/Age

Gender *

Male
Female

Spayed or Neutered? *

Any Known Allergies/Reactions? *

If Yes, please elaborate:

Is your pet’s Rabies vaccine up to date? *

When is the last time your pet was seen by a veterinarian? *

Who was your pet’s previous veterinary clinic? *

Would you like to add information for a second pet? *

Pet's Name *

Species *

Canine
Feline

Breed

Color

Date of Birth/Age

Gender *

Male
Female

Spayed or Neutered? *

Any Known Allergies/Reactions? *

If Yes, please elaborate:

Is your pet’s Rabies vaccine up to date? *

When is the last time your pet was seen by a veterinarian? *

Who was your pet’s previous veterinary clinic? *

Would you like to add information for a third pet? *

Pet's Name *

Species *

Canine
Feline

Breed

Color

Date of Birth/Age

Gender *

Male
Female

Spayed or Neutered? *

Any Known Allergies/Reactions? *

If Yes, please elaborate:

Is your pet’s Rabies vaccine up to date? *

When is the last time your pet was seen by a veterinarian? *

Who was your pet’s previous veterinary clinic? *

Owner Information

Owner Name *

First

Last

Employer

Spouse/Other

Spouse Employer

Home Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Which phone numbers would you like to share with us? *

Cellular
Landline
Work
Spouse

Cellular *

Landline

Work

Spouse phone number

Email *

I would like to receive my pet's reminders by email:

Whom may we thank for referring you to us? (check one)

Friend or Relative
Google Search
Facebook
Instagram
Drove By
Staff Member
Shelter or Pet Store
AKC Veterinary Network
Other

If they are clients at our hospital, whom may we thank?

Which staff member?

If Other, please elaborate how you found us

Credit Policy: We ask that all fees be paid at the time of service. We accept cash, personal checks (with identification), Visa, MasterCard, Discover, American Express, CareCredit, ScratchPay, and VetBilling Payment Plans. Exceptions must be cleared with the Practice Manager prior to service, and completion of a credit form will be required. Past due accounts are subject to late fees and those turned over to collection are subject to collection and/or legal fees. *

I have read and understand

Ask about our flexible payment options, rewards program and Pet Health Savings Accounts.

Social Media/Photo Permission: Do we have your permission to post photos of your pet online? *

Please type your initials. *

Date *

Name

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 – 5:00PM
Thur: 8:00AM – 7:00PM
Sat: 8:00AM – 12:00PM

Contact Information

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