Welcome to Elk Creek Animal Hospital!

Client/Patient Form

Name: Elk Creek Animal Hospital
Address: 6003 Morningside Ave., Sioux City, IA, 51106, United States
Telephone: 712-276-5368
Price range: $

Get Started

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Thank you for considering Elk Creek Animal Hospital for your pet’s needs!

If you are a new client with us, or you’re an existing client and you need to update your information, please fill out the client registration form in its entirety to ensure we can provide you and your pet with the best possible care.

Client Information

Client/Primary Owner Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Is it a home or mobile number?(Required)

Home Number

Mobile Number

Work Phone

Would you like to receive reminders and updates via Text Message?(Required)

Yes

Place of Employment(Required)

Occupation(Required)

Driver’s License #(Required)

State(Required)

Email(Required)

Would you like to receive reminders and updates via email?(Required)

Yes

Emergency Contact

Name(Required)

Relation(Required)

Phone(Required)

Is it a home or mobile number?(Required)

Home Number

Mobile Number

Secondary Owner Contact Information

Secondary Owner Name

First Last

Same as emergency contact

Yes

Relation to primary owner

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number

Is it a home or mobile number?

Home Number

Phone Number

Work Number

Place of Employment

Occupation

Please note:

ALL fees are due at the time services are rendered!

Pet Information

Name(Required)

Species(Required)

Date of Birth/Approximate Years Old(Required)

Breed(Required)

Color(Required)

Male or Female?(Required)

Female

Male

Spayed/Neutered?(Required)

Yes

Last Seen At:(Required)

Would you like to add a second pet?(Required)

Yes

Second Pet

Name

Species

Date of Birth/Approximate Years Old

Breed

Color

Male or Female?

Male

Female

Spayed/Neutered?

Yes

Would you like to add a third pet?

Yes

Third Pet

Name

Species

Date of Birth/Approximate Years Old

Breed

Color

Male or Female?

Male

Female

Spayed/Neutered?

Yes

Last Seen At:

Read and initial:

I understand that if I fail to keep my pets current on all of their required vaccines that they will not be eligible for emergency services after the clinic’s regular business hours in the event that I need them to be seen by a veterinarian.(Required)

All fees are due and payable upon release of the patient. If the patient has to be admitted, a deposit will be required at the time.(Required)

I am aware that my balance will be doubled if this account is assigned to an outside agency for collections. I am also aware that there is a $30.00 charge for returned checks, and they are subject to prosecution by the district attorney’s office.(Required)

I give Elk Creek Animal Hospital permission to obtain my pet’s medical history from other animal hospitals and share my pet’s medical history with other Veterinarians upon request.(Required)

By providing your mobile number and checking the consent box below, you consent to receive SMS and MMS messages from Elk Creek Animal Hospital. This may include promotional messages, service updates, and other relevant notifications. Consent is not a condition of treatment. Message and data rates from your carrier may apply. Message frequency varies. Unsubscribe at any time by replying STOP. Reply HELP for message assistance.(Required)

I consent to receive SMS/MMS messages from Elk Creek Animal Hospital at the following mobile phone number

I do NOT consent to receive SMS/MMS messages from Elk Creek Animal Hospital at this time.

For more information, please review our privacy policy. Reply STOP to unsubscribe from SMS messages. Messaging and data rates may apply.

Signature(Required)

Date(Required)

MM slash DD slash YYYY

CAPTCHA

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Location

6003 Morningside Ave.
Sioux City, IA 51106

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Contact

712-276-5368
pets@elkcreekvet.com

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Hours

Mon, Wed & Fri
7:30 AM - 5:30 PM

Tues & Thursday
7:30 AM - 6:00 PM

Sun - Sat
Closed

We look forward to your visit!

Your Doctors,

Dr. Aaron Bessmer

Dr. Kalene Gross

Schedule Appointment

Have a question?

Get in touch! Complete the form below, and a member of our team will reach out to you shortly. If you're in need of immediate assistance, please contact us at 712-276-5368.

Name *

First

Last

Email *

Phone

How can we help you? *

I consent to receive SMS/MMS messages from Elk Creek Animal Hospital at the following mobile phone number
I do NOT consent to receive SMS/MMS messages from Elk Creek Animal Hospital at this time.

For more information, please review our privacy policy.

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