• Our Hospital
    • About Helena
      Veterinary
      Clinic
    • Payment
      Solutions
    • Client Forms
    • Our Videos
  • Our Services
    • Preventive Care
    • Wellness Exams
    • Vaccinations
    • Early Detection Testing
    • Parasite Prevention
      And Control
    • Nutritional Counseling
    • Pharmacy
    • Microchipping
    • General Medicine
    • Pet Allergies And
      Dermatology
    • Dental Care
    • Surgery
    • Boarding
    • Grooming
  • Client Forms
  • Resources
    • Blogs
    • News &
      Promotions
    • Pet Resources
    • FAQs
  • Home Delivery
  • Reviews
  • Contact
  • 205-236-0500
Helena Veterinary Clinic
Helena Veterinary Clinic
Schedule Your Appointment
205-236-0500
Helena Veterinary Clinic Logo
Schedule Your Appointment
205-236-0500
    Helena Veterinary Clinic Logo
  • Our Hospital
    • About Helena
      Veterinary
      Clinic
    • Payment
      Solutions
    • Client Forms
    • Our Videos
  • Our Services
    • Preventive Care
    • Wellness Exams
    • Vaccinations
    • Early Detection Testing
    • Parasite Prevention
      And Control
    • Nutritional Counseling
    • Pharmacy
    • Microchipping
    • General Medicine
    • Pet Allergies And
      Dermatology
    • Dental Care
    • Surgery
    • Boarding
    • Grooming
  • Client Forms
  • Resources
    • Blogs
    • News &
      Promotions
    • Pet Resources
    • FAQs
  • Home Delivery
  • Reviews
  • Contact

"Improving lives through personalized care. We treat you like family and each patient like our own pet."

"Improving lives through personalized care. We treat you like family and each patient like our own pet."

"Improving lives through personalized care. We treat you like family and each patient like our own pet."

Patient Forms

Thank you for giving us the opportunity to care for your pet! Please click on the link to the form that you need. When the form has downloaded, please print and complete the information sheet and bring it to the hospital at the time of your appointment.

  • New Patient Form

    Download
  • Patient Surgery Information Form

    Download
  • Drop Off Admission Form

    Download
  • Dog Grooming Instructions Form

    Download
  • Cat Grooming Instructions Form

    Download
  • Boarding Form

    Download

      We are pleased to welcome you to our practice. Please take a few minutes to fill out this form as completely as
      you can. If you have any questions, we’ll be glad to help you. We look forward to working with you in caring for your pets’ health needs.

      *Required Fields

      All About You!

      *Name:
      Spouse:
      *Email Address:
      *Address:
      City:
      State:
      Zip:
      Home Phone:
      *Cell Phone:
      Work Phone:
      Spouse Cell:
      Spouse Work Phone:
      Referred by?
      How many fur babies do you have?
      Dogs
      Cats

      Pet Health History

      Pet's Name:
      Breed:
      Color:
      Date of Birth:
      Vaccination History:
      Pet's Current Medications:
      Any known drug allergies?
      Describe your pet's diet:

      Authorization:

      I hereby authorize the veterinarian to examine, prescribe for or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment. I understand that any animal not called for by the owner will be considered abandoned and shall be disposed of at the discretion of the hospital. My financial responsibility shall not in any way be altered by such disposal and my indebtedness shall include all charges made against such animal up to and including the date of, and charge for disposal of same. Should it be necessary to collect on this account through an attorney, the undersigned agrees to pay all costs of collection, including reasonable attorney’s fees.

      I understand that I assume full financial responsibility for all services and that PAYMENT IS DUE AT TIME OF SERVICE. A $30.00 fee is assessed for all returned checks.

      PLEASE NOTE THAT ALL PATIENTS MUST BE CURRENT ON ALL VACCINES PRIOR TO ADMISSION.

      E-Signature:
      Date:
      Thank you for completing this form!
      You are missing required fields.
      Dynamic Error Description
      There was an error processing this form.

      Patient Surgery Information Form

      *Required Fields

      *Patient Name

      *Owner

      *Email Address:

      *Phone Number

      What type of surgery is your pet scheduled for today?

      Have you given your pet any medications today?

      Has your pet eaten or had water this morning?

      Is your pet having any additional issues the Doctor needs to know about?

      Is your pet allergic to any medications that you are aware of?

      Microchipping with Home Again for $48

      *We recommend and encourage Pre-Operative bloodwork to ensure, to the best of our ability, that your Loved One has a safe and effective procedure and recovery.

      Would you prefer pre-operative bloodwork with this procedure today?

      In the event that emergency treatment is required and I cannot be reached, I authorize the doctors and staff at Helena Veterinary Clinic to perform medical and surgical treatment as is necessary to preserve the life of the patient until I can be contacted for further authorization. I understand that no guarantee of successful treatment has been made. I accept financial responsibility for the treatment of the above named patient and understand that payment is due in full upon release of the animal from the hospital or when services are otherwise terminated. I realize that in many cases it is impossible to determine in advance the extent of medical or surgical treatment required for an animal. In such cases, the hospital staff will attempt to estimate depending upon the extent of treatment required. I understand that my pet is required to be up to date on vaccines, including but not limited to; Rabies, Bordetella, DAPP (canine), FVRCP (feline), and that Helena Veterinary Clinic will vaccinate your pet as needed to comply with this requirement.

      *Date

      Thank you
      You are missing required fields.
      Dynamic Error Description
      There was an error processing this form.

      Drop Off Admission Form

      *Required Fields

      *All pets going into our kennel area will be given a Capstar, a 24- hour flea dose ($8.50)
      * Your pet must be up to date on Rabies, Distemper/Parvo, Bordatella, and or FVRCP vaccinations to be dropped off*

      I hereby authorize Helena Veterinary Clinic, and its doctors and staff to administer such treatment and to perform such procedures as considered therapeutically and diagnostically necessary for the care of my pet:

      Being seen today for:

      * In the event that emergency treatment is required and I cannot be reached, I authorize the doctors and staff to perform medical and surgical treatment as is necessary to preserve the life of the patient until I can be contacted for further authorization. I understand that no guarantee of successful treatment is made. I accept full financial responsibility for the treatment of the above-named patient and understand that payment is due in full release of the animal from the hospital or when service is otherwise terminated. I realize that in many cases it is impossible to determine in advance the extent of medical or surgical treatment required for an animal. I certify that I have read and understand this authorization. I hereby release Helena Veterinary Clinic DBA Southern Vet Partners, it’s doctors, and staff from all claims; except for claims of negligence arising out of, or connected with, the performance treatment.

      *Email Address:

      *Date:

      *Home Again Microchip $48.00

      *Authorization to use credit card on file for charges:

      Thank you
      You are missing required fields.
      Dynamic Error Description
      There was an error processing this form.

      Dog Grooming

      *Required Fields

      *Pets Name

      If you would like “Breed Standard” cut, please specify:

      OR, if you would like a Bath n Tidy, please initial here:

      (A Bath n Tidy will include: Bath, Nail Trim, External Expression of Anal Glands, Potty Path, Face and paws trimmed.)

      OR, you may choose your coat length:

      Additional Notes:

      Poodle Feet (additional $10.00)

      Dremel Nails (additional $10.50)

      Veterinary Services Needed:

      Clinic policy requires all pets to be current on Rabies, Distemper/parvo and Bordatella. Your pet will be given a Capstar for flea prevention at a cost of $8.50. IF YOUR PET HAS TICKS, WE APPLY A PREVENTION/TICK KILLER at owners cost.

      *Permission to Sedate for Grooming (Please Initial):

      *Date

      *Email Address:

      *Phone Number

      Thank you
      You are missing required fields.
      Dynamic Error Description
      There was an error processing this form.

      Cat Grooming

      Please note that Sedation is required for most cats.

      *Required Fields

      *Pets Name

      Cut up to:

      Tail

      Head

      Clinic Policy requires all pets to be current on:

      • Rabbies

      • FVRCP

      • Feline Bordatella

      Receptionist cannot guarantee pick-up times. Thank you for your letting us take care of your pet!

      *Permission to Sedate for Grooming

      *Date

      *Email Address:

      *Phone Number

      Thank you
      You are missing required fields.
      Dynamic Error Description
      There was an error processing this form.

      Boarding Release Form

      *Required Fields

      *Pet Name

      *Owner

      *Arrival Date
      *Departure Date

      *Who will pick up your pet(s)?

      *Emergency Phone

      *Email Address:

      Choose any additional services your needs

      *Has your pet eaten today?

      How often does your pet eat?

      Would you like kennel food for your pet? If not, what brand/type of food are you bringing for your pet's stay?

      Does your pet take medication?

      Have you given your pet any medications today?

      Are there any special instructions that we should know about for your pet?

      Would you like to authorize the use of your credit card on file for charges?
      I, the undersigned, certify that I am the owner, or authorized agent of the owner, of the above animal. In the event of a medical problem or an emergency, I authorize the doctor and assistants to perform any necessary medical procedures. I understand that I am responsible for payment of any procedures done. I also understand that my pet must be current on all required vaccinations and flea prevention for the protection of my animal and the other animals as well. If I cannot provide proof of a current vaccination status on my pet, my pet will be updated while at Helena at my expense. I also understand that Helena Veterinary Clinic is not responsible for any lost, damaged or misplaced items during my pet's stay. ***If fleas or ticks are found on your pet during stay, we will apply a dose of preventative at owner's cost***

      Helena Veterinary Clinic Boarding Liability Waiver Any references below to the word “I” also implies all others associated with me, included but not limited to mt spouse, heirs, assignees, and family members.

      This section applies to anyone who brings their pet on the Helena Veterinary Clinic premises for any reason.:

      I have disclosed to Helena Veterinary Clinic all known risks, dangers and medical conditions associated with my pets.

      I understand that I am solely liable for medical care expenses and damages that result from injuries caused by my pet.

      I understand that Helena Veterinary Clinic may refuse service to my pet for any reason it deems necessary, including but not limited to overly aggressive behavior, overly excessive barking and illness.

      I agree that there are inherent risks in sending my pet to any boarding facility, such as illness, injury, and I accept these risks because they are outweighed by the benefits. Helena Veterinary Clinic will not be liable for illness or injury that may occur to my pet.

      I authorize Helena Veterinary Clinic to take actions they deem necessary to ensure the health, wellbeing and safety of my pet and to take reasonable action to resolve any medical problems that may arise while my pet is in their care. I agree to assume full financial responsibility for any and all expenses incurred as a result of their actions. I understand that Helena Veterinary Clinic’s staff is expected to make a reasonable attempt to contact me before incurring such expenses. However, that there is always the possibility of emergency situations where it may not be feasible for them to contact me before the expense is incurred.

      I waive all claims or actions against Helena Veterinary Clinic relating to the care, control, health, and safety of my pet while in their care.

      Certify that:

      • I am the legal owner of the dog/cat I am sending to board with Helena Vet Clinic.

      • That, to mt knowledge, my pet has not been exposed to kennel cough, distemper, rabies, or parvovirus within the past 30 days.

      • Owner acknowledges that all pets must be up to date in vaccines.

      *E-signature

      *Date signed

      Thank you
      You are missing required fields.
      Dynamic Error Description
      There was an error processing this form.
      Request Appointment
      Pet Portal login
      Meet the team
      Our Services
      Testimonials
      Contact Us

      Pet Health Articles

      • Dogs
        • Canine Distemper
        • Canine Parvovirus
        • Picking Your Perfect Puppy
      • Cats
        • Feline Distemper
        • Picking Your Perfect Cat
      • Health
        • Dental Hygiene and Oral Care
        • Euthanasia
        • Feeding Your Pet
        • Flea Prevention and Care
        • General Pet Safety
        • Heartworm
        • Heat Stroke Awareness
        • Pet Grooming
        • Pet Obesity
        • Recognizing An Ill Pet
        • Seasonal Care
        • Ticks
        • Vaccinations and Examinations
      • General
        • Bringing Your Pet Home
        • Pets and Kids
        • How to Adopt
        • Traveling with Your Pet
        • Training Your Pet
        • Finding A Reputable Breeder
      Helena Veterinary Clinic Pharmacy

      Enjoy your visit? Review us here!

      Request Appointment

      Thank you
      You are missing required fields.
      Dynamic Error Description
      There was an error processing this form.

      Main

      • Our Hospital
      • Veterinary Care
      • News & Promotions
      • Home Delivery
      • Boarding
      • Grooming
      • Pet Resources
      • Reviews
      • Contact
      • Sitemap

      Contact Information

      • 1888 Hwy 95 Helena, AL 35080
      • 205-236-0500
      • Send Email
      Helena Veterinary Clinic

      Clinic Hours

      • Monday:
        7:00am - 6:00pm
      • Tuesday:
        7:00am - 6:00pm
      • Wednesday:
        7:00am - 6:00pm
      • Thursday:
        7:00am - 6:00pm
      • Friday:
        7:00am - 6:00pm
      • Saturday
        7:00am - 12:00pm
      • Sunday
        4:00pm - 5:00pm
      Helena Veterinary Clinic
      Veterinary Websites by Roya
      Helena Veterinary Clinic
      Helena Veterinary Clinic Logo
      Southern Veterinary Partners © echo Date('Y') ?>

      Send Us A Message

      Form submitted successfully!
      You are missing required fields.
      Dynamic Error Description
      There was an error processing this form.

      Request Appointment

      Complete the form below and We will get back to you to confirm your schedule.
      Your Informations is SAFE with us
      Form submitted successfully!
      You are missing required fields.
      Dynamic Error Description
      There was an error processing this form.

      Login


      Forgot Password?

      OR

      Sign in with Facebook Sign in with Google


      Looking to create an account ?
      Already have an account? Login

      Save Search


      Saved Searches

        Update Profile