Patient History

Bissonnet Southampton Veterinary Clinic

Address: 2028 Bissonnet Street
Houston, TX 77005

Call: (713)520-8743

Hours:

Mon 7:30 a.m. - 6:00 p.m.

Tue 7:30 a.m. - 6:00 p.m.

Wed 7:30 a.m. - 6:00 p.m.

Thur 7:30 a.m. - 6:00 p.m.

Fri 7:30 a.m. - 6:00 p.m.

Sat 7:30 a.m. - 1:00 p.m.

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Bissonnet Southampton Veterinary Clinic

2028 Bissonnet Street
Houston, TX 77005

(713)520-8743

www.bissvet.com

This form is for GROOMING services only. Please use the appointment check-in form if your pet needs any other services in addition to grooming.

By completing this online form, I authorize the performance of requested procedures and/or any related procedures deemed necessary by the veterinarian. I understand and acknowledge that no guarantee has been made regarding the results of the intended or any other unexpected but necessary treatment.

I understand that I assume financial responsibility for all services rendered and know and agree that payment is due on the date of services.

Grooming appointments - We will call you when your pet is ready.

Grooming Check-In Form

Client Name (required)

First Name (required)	Last Name (required)

Phone number where you can be reached (required)
Phone Type	Phone Number (required)

Appointment Date: (required) :

Pet's Name (required)

Requested Services: (required)
Bath (Nail trim, clean ears, EAG)
Medicated Bath (Nail trim, clean ears, EAG)
Dremmel Nails
Shave (limited shave options - please specify)
Brush teeth (includes toothbrush/toothpaste for home use)

Additional Requests:

Do you need any refills of medications, heartworm preventative, flea preventative, or food today? If so, please list.

How would you like to pay for this visit? (required)

Card on File
Provide credit card at visit
Care Credit
Cash
Check

This form is for GROOMING services only. Please use the appointment check-in form if your pet needs any other services in addition to grooming.

I authorize the performance of requested procedures and/or any related procedures deemed necessary by the veterinarian. (required)
Yes, I authorize the performance of requested procedures for my pet.

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