Tri-City Animal & Bird Clinic

15646 Manchester Road
Ellisville, MO 63011


New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

Thank you for your cooperation in letting us assist you.

New Client

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
State / Province (required)
Zip / Postal Code (required)
Home Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address :
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :

Sex: (required)


Are your pets vaccines current?
Do you have pets medical records?
Medical records at another veterinary Practice?

Name of Former Veterinary Practice

May we request a transfer of records?

Would you like us to call you for your appointment
Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here

Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Tri-City Animal & Bird Clinic and that charges are due and payable at the time of service.
I have read this statement and -
I Agree
I Disagree

Check the reCAPTCHA to ensure you are not a robot: