Schedule Appointment Online Pharmacy (469) 612-5130
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    • Dr. Tasha Kirkpatrick
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  • Contact Us
  • Home
  • About Us
    • Dr. Holly Killman
    • Dr. Tasha Kirkpatrick
    • Dr. Kristina Janson
    • Our Locations
  • Our Services
    • After-Hours Emergency Information
    • Boarding
    • Breeding Management
    • Canine Reproduction
    • Dental
    • Dermatology
    • Diagnostic Imaging
    • Equine Reproduction
    • Heartworm Testing
    • Hospice/Euthanasia
    • House Calls
    • In-clinic Diagnostics
    • Intensive Care
    • Microchipping
    • Nutritional Counseling
    • Pain Management
    • Pharmacy
    • Surgery
    • Ultrasound
  • FAQs
  • Forms
    • New Client Form
  • Links
    • American Heartworm Society
    • Companion Animal Parasite Council
    • ASPCA Poison Control
    • Care Credit
  • Contact Us

New Client Form

New Client Form

New Client Form

New Client Form

Welcome to Gully Animal Hospital! Thank you for giving us the opportunity to care for your pet! So we may provide you with exceptional service, please share a little information about you and your pet(s). Our mission is to provide the most compassionate medical care for your pets.
REGISTRATION
May we email you reminders about your pets?

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PET HEALTH HISTORY
Pet #1
Species:
Sex:
Spay/Neuter:
Microchipped?
Does your pet have any allergies, special medications, or health problems we should know about?
Does you have pet insurance on this pet?
Pet #2
Species:
Sex:
Spay/Neuter:
Microchipped?
Does your pet have any allergies, special medications, or health problems we should know about?
Does you have pet insurance on this pet?
Pet #3
Species:
Sex:
Spay/Neuter:
Microchipped?
Does your pet have any allergies, special medications, or health problems we should know about?
Does you have pet insurance on this pet?

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How did you hear about us?
AUTHORIZATION
**To aid in preventing the spread of infectious diseases, all patients staying in our hospital must be current on ALL vaccinations and free of internal and external parasites. If your pet has internal or external parasites, it will be treated at the owner's expense.

I hereby authorize the veterinarian to examine, prescribe for, or treat the described pet(s). I assume responsibility for all charges incurred in the care of this animal. I understand that these charges must be paid at the time of services rendered and a deposit may be required for surgical or hospitalization treatments. We accept all major credit cards, cash, and Care Credit.

By entering my name, I acknowledge that I have read Gully Animal Hospital Midlothian's Authorization form and agree to adhere to their policies and procedures.

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Contact Information

Office Address: 114 Roundabout Drive
Midlothian Texas, 76065

Phone: (469) 612-5130
Email: SEND EMAIL
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​​​​​​​​​​ EMERGENCY SERVICES CLINICS

Hours of Operation

Monday: 7:00AM - 8:00PM
Tuesday: 7:00AM - 8:00PM
Wednesday: 7:00AM - 8:00PM
Thursday: 7:00AM - 8:00PM
Friday: 7:00AM - 8:00PM
Saturday: 8:00AM - 4:00PM
Sunday: Closed

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