How to Complete the Form

Step 01 – Fill out all required fields in the online form below.

Step 02 – Upload or email any prior medical records if available.

Step 03 – Click “Submit” once finished.

After submission, our team will review your information and contact you if additional details are needed.

New Client Form

Please complete this form as thoroughly and accurately as possible so we can best understand your pet’s veterinary needs.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Do you agree to receive text messages from Ehlers Animal Care? *

I agree

By checking this box, you consent to receive informational and/or promotional text messages from Ehlers Animal Care at the number provided, including messages sent by the autodialer. Consent is not a condition of purchase. Message & data rates may apply. Message frequency varies. Unsubscribe at any time by replying STOP. Reply HELP for help. Privacy Policy.

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare?

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Do you have a second pet? *

Breed microchip cat,

Need Immediate Assistance?

If your pet is experiencing an urgent medical concern, please do not wait for form confirmation. Call our clinic directly at (402) 420-7020 so we can assist you promptly.

New Client Form

How to Complete the Form

New Client Form

Need Immediate Assistance?

Contact Us

Location

Hours

Have a question?