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New Patient Form

If your horse is a new patient at Equine Surgery & Medicine, please fill out our New Patient Form.

Option 1

Complete Online

Complete and submit the online form below.

Option 2

Complete on Arrival

If you prefer, fill out the form when you get to our hospital.

New Patient Form

Owner Information

Barn Information

Farrier Information

Emergency Contact

Patient Information


By submitting this form, I hereby authorize Equine Surgery & Medicine to render medical care for my pet(s) as deemed necessary by the veterinarian.

I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate.

I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Equine Surgery & Medicine.

Schedule an Appointment Today

Equine Surgery & Medicine is accepting new patients. Our team of veterinarians has been providing expert equine care since 1975. Get in touch with us today to book an appointment.

Contact Us

(316) 744-2007 Contact