Welcome Brooks Rd Animal Hospital clients to the Desoto County family – we’re excited to continue providing exceptional care for your beloved pets!

Online form

New Client Form Desoto County Animal Clinic in Southaven, MS

Thank you for supporting Desoto County Animal Clinic! Our story is a great one, and it’s all centered around providing the best care for your pet.

Get Started

New Client Registration 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.
OR
You may use the PDF version by clicking the DOWNLOAD FORM button and then completing the printed form by hand. Please bring the completed PDF form with you for your pet’s first appointment.

DOWNLOAD FORM

Name *

First

Last

Date *

Co-Owner/Spouse Name

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Work Phone

Co-Owner/Spouse’s Phone

Co-Owner/Spouse’s Work Phone

Email *

YOUR DRIVERS LICENSE IS REQUIRED AT REGISTRATION FOR IDENTIFICATION AND INFORMATION VERIFICATION. ALL FEES ARE DUE AND PAYABLE AT THE TIME SERVICES ARE RENDERED. WE DO NOT OFFER FINANCING OR IN-HOUSE CREDIT!

We accept the following forms of payment: Cash, Check, Visa, Mastercard, Discover, American Express and Care Credit.

How did you become aware of our clinic?

Yellow Pages
Sign
Newspaper
Internet
Clipper Magazine
Flyer

Personal Recommendation (Whom may we thank?)

Do you have pet insurance? If so, which company do you use?

Occasionally, photos of pets are included on our website and our Facebook page. In order for your pet’s image to be included in either of these areas, DCAC, Inc. must have your written permission on file. Check One:

YES, DCAC, Inc does have permission to use images of my pet on the website and Facebook page.
NO, DCAC, Inc does NOT have permission to use images of my pet on the website and Facebook page.

Pet 1

Name *

Species *

Dog
Cat
Bird
Other

Phone *

Breed *

Color *

Age *

Sex *

Male
Female

Has your pet been spayed or neutered? *

Special Diet/Medications:

Where were they administered?

What vaccs were administered?

Pet 2

Name

Species

Dog
Cat
Bird
Other

Breed

Color

Age

Sex

Male
Female

Has your pet been spayed or neutered?

Any Known Allergies?

Special Diet/Medications:

Date of last known vaccinations:

Where were they administered?

What vaccs were administered?

Please note: Current vaccinations by a licensed veterinarian are required for the admission of your pet to our hospital. Owner administered vaccinations are not acceptable. This includes admission for elective surgery, boarding, grooming and well animal care. Proof of vaccinations is required prior to admission and is the responsibility of the client.

I agree to allow the doctors and staff of Desoto County Animal Clinic to treat my pet and I accept responsibility for all accumulated fees associated with the care that my pet(s) receive. I understand that I am responsible for payment in full prior to discharge according to Desoto County Animal Clinic policy and will be held responsible for service or collection fees if balance is not paid in full.

Client Signature *

Clear Signature

Date *

Ready for a visit?

We proudly serve the pets of Mississippi – Olive Branch, Horn Lake, Nesbit, Hernando, Southaven in Tennessee, Memphis, and surrounding areas. We look forward to seeing you and your pet. Easily book an appointment for your pet by using our online system!

Book Appointment

Have a Question?

Once you’ve filled out our online form, a member of our staff will be in touch with you right away.

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Our Location

8330 Hwy 51 N,
Southaven, MS 38671

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Contact Information

P: 662-342-4899
E: [email protected]

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Hours

Mon–Fri: 7:00am – 5:00pm
Closed for Lunch: 12:30pm – 1:30pm
Sat-Sun: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

Website