555 Trinity Creek Cove, Cordova, TN 38018 US
(901) 624-9002

New Patient Form

If your pet is a new patient at our hospital, please fill out our New Patient Form using one of the options below. 

Once you have completed the New Patient Form, please also complete the Specialty Form for the veterinary specialist your pet has been referred to. 

Specialty Forms

OPTION 1
Complete Online

Complete and submit the form below.

OPTION 2
Print & Complete

Bring the completed form with you.

Download Form

OPTION 3
Complete on Arrival

If you prefer, you can complete the form when you get to our hospital.

New Patient Form

Please provide us with the following information. 

Client Information

Note: At your first appointment at our hospital, we may ask to collect your driver's license and social security number for payment collection purposes. We will also require a photo copy of your license.

Patient Information

Photography Release Form

Memphis Veterinary Specialists & Emergency uses public social media forms, as well as other digital and print media to promote pet health, educate the community about our services, and share the faces and stories of our beloved patients.

Payment Information

I understand I am financially responsible to Memphis Veterinary Specialists & Emergency for all charges. I understand that payment is due in full at the time services are rendered. I agree to pay all interest, collection, legal, attorney or court fees in the event it becomes necessary to pursue the account for collection. If your account is placed in a collection agency, a collection-fee of up to 33.3% may be added to your account and shall become a part of the Total Amount Due. We accept cash, checks, major credit cards and Care Credit. TeleCheck authorizes all checks. When you provide a check as payment, your authorize us to use information from your check to process a one-time payment Electronic Funds Transfer (EFT), a draft drawn from your account or to process the payment as a check transaction. Unless specifically requested, all pets needed emergency care while staying in our hospital will be treated until the owner / agent can be contacted.

By submitting this form, I agree to the above.

From Happy Pet Owners

  • "My little guy had the best knowledgeable care, I felt very welcomed, and everyone was very generous. Thank you, MVS!”
    Kathy W.

(901) 624-9002