New Client Form

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

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New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. You can also download the form by clicking the button below.

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Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Fax Number

Work Phone

Cell Number

Email *

Place of Employment

Spouse/Relative

Phone

We now accept CareCredit! Please see Receptionist to apply today and receive approval while you wait!

All Fees Are Due At The Time Services Are Rendered unless deemed an Emergency by Dr. Odom:

Please Indicate Choice of Payment

Cash/Check
Visa
MasterCard
Amex

If you wish to pay by check, please be aware there is a $32 NSF fee, should litigation of collection be necessary, all additional costs will be billed to the client. A service charge of 2% is added to all balances over 30 days. A billing charge of $1 is added to each monthly statement.

How did you become aware of our clinic?

If Other. Please Specify *

Personal Recommendation (Whom may we thank?)

Pet's Name *

Breed *

Date of Birth *

Color *

Sex *

Male
Neutered Male
Female
Spayed Female

Your Pet’s Vaccination History

Place of Vaccinations

Phone Number

Heartworm Test/Prevention?

Our Pet(s) Is

Member of our family
Child’s pet
Backyard pet

Any Previous Serious Illnesses or Surgeries?

Any Allergies to Vaccinations or Medications?

Is Your Pet on Any Special Diets or Medications?

Would You Like to Be Present During Treatment to Your Pet? *

If Yes, Please Specify *

Are There Other Persons That Have Permission to Use Your Account? *

If Yes, Please Specify *

Name *

Date *

Name

Ready To Book An Appointment?

Odom Veterinary Hospital is dedicated to offering extensive, lifelong support for your cherished pets. We proudly serve the entire region spanning from Pine Bluff, Arkansas, all the way down to Georgetown, Louisiana, encompassing North Louisiana and Southern Arkansas.

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Questions?

Get in touch! We look forward to hearing from you.

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Location

160 N Spillway Rd Farmerville, LA 71241

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Contact Information

Phone: (318) 368-6060
Email: ovh@odomvet.com

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Hours

Monday – Thursday: 7:30 am – 5:00 pm
Friday: 7:30 am – 12:00 pm
Saturday – Sunday: Closed

We won Union Parish Chamber of Commerce’s Outstanding Citizen in Business for 2022

Name *

First

Last

Email *

Phone

How can we help you? *

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