belmontanimalhospitalnc@gmail.com
704-266-3440


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Appointment

Home
About
Services
Resources
Contact
Shop Now
Appointment

Urgent care and same-day appointments available!

Please Note: We will be closed on Tuesday, 24th December and Wednesday, 25th December in observance of Christmas!

ONLINE FORMS

NEW CLIENT FORM

Save time during your new client appointment! Complete your required forms online from any device at any time before your visit.

New Clients Existing Clients

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pets before your visit.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a second pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a third pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fourth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fifth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

How Can We Help You? *

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your Pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your Pet. We accept Cash, Visa, MasterCard, Discover, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

Comment

READY FOR A VISIT?

Schedule Your Appointment

Thank you for considering Belmont Animal Hospital. We proudly serve Belmont, Mt Holly, McAdenville, Gastonia, Lake Wylie, and West Charlotte. We’re excited to meet you and your pets and embark on this journey together. Please click below to make an appointment.

Book Appointment

Have Questions?

Please contact us! Fill out our online form, and a member of our staff will contact you shortly.



Our Location

1806 South Point Rd
Belmont, NC 28012



Contact Us

Call: 704-266-3440
Email: belmontanimalhospitalnc@gmail.com



Our Hospital Hours

Mon – Fri: 8:00 am – 5:30 pm
Sat: 8:00 am – 2:00 pm
Only open the first Saturday of the month

Name *

First

Last

Email *

Phone

How can we help you? *

Website

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