Welcome!

New Client Form

Please fill out the following form before your scheduled appointment.

Welcome New Clients!

Thank you for choosing Cooper Veterinary Clinic! Please fill out the following form to the best of your ability before your scheduled appointment. If you have any questions, please feel free to call us at 806-687-0687. If you would rather print and fill out the form at home, please click the button below.

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New Client Form

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Home Phone *

Cell Phone *

Work Phone *

Best Time to Reach You *

Place of Employment

Driver's License #

How did you hear about our clinic?

What is your payment of choice? *

Check/Cash
Visa
MasterCard
Discover
CareCredit

NOTE: All payments are due at the time services are rendered.

Patient Information

Pet's Name *

Date of Birth *

Species *

Canine
Feline

Pet's Breed *

Is your pet spayed or neutered? *

Is your pet microchipped? *

Is your pet on any specific medication? If so please list them for us:

Does your pet have any behavior problems we need to be aware of?

Has your pet had any major surgeries other than being spayed or neutered?

If you do not have copies of your pet’s medical history from your pervious veterinarian, please give us the clinic name and we will have them faxed over:

May we use images of your pet on our social media?

Authorization: I hereby give my veterinarian permission to examine, prescribe for and treat my pet. I take responsibility for all charges. I also understand that the charges will be paid in full at the time they are performed. *

Clear Signature

Date *

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Address

12105 Indiana Ave
Lubbock, TX 79423

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Emergencies

Lubbock Small Animal Emergency Clinic
6305 66th St # 300
Lubbock, TX 79424
806-797-6483

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Email

[email protected]

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Phone

806-687-0687

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Hours

Mon–Wed & Fri: 7:30 am to 6 pm
Thur: 8 am – 5 pm
Sat: 9 am to 12 pm
Sun: Closed

Have a Question?

Please fill out the form below and a member of our team will get back to you shortly!

Name *

First

Last

Email *

Phone

How can we help you? *

Message

Stay connected with your pet's health.

Keeping up with your pet’s health from your mobile device has never been easier! With our new PetDesk app, you’ll have all of your pet’s health information in the palm of your hand. Plus, you’ll be able to communicate with us easily. You’ll be able to book appointments 24/7 and receive automatic reminders!

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