News & Events
GCVS Referral Portal
For Emergencies Call
For Specialty Appointments
Open 24/7/365 for emergencies at
8042 Katy Freeway
Contact & Location
Back to All Forms
Address Line 2
State / Province / Region
ZIP / Postal Code
Owner Employment Information
Co-Owner Employment Information
General / No Specialty
Avian & Exotics
Dentistry & Oral Surgery
Dermatology & Allergy
Emergency & Critical Care
Neurology & Neurosurgery
Rehabilitation & Fitness
Surgery & Orthopedics
Birth Date / Approximate Age
How long have you owned this pet?
Are vaccinations current?
Who is your pet's regular veterinarian?
Who referred your pet to our hospital?
Reason for Referral (primary complaint)
Please list an of your pet's drug allergies or special problems that we should know about.
Have any doctors at GCVS (any department) seen any of your pets in the past?
Did you bring (or mail in) X-rays and/or medical records from your veterinarian?
Would you like to receive information and updates from GCVS?
We are always looking for patient stories to share with our community!
Please check here to give permission to use your pet's photo and/or story for social media, educational, print publications or related endeavors.
Yes, I am ok with Gulf Coast Veterinary Specialists sharing my pet's picture and story.
No, I would prefer not to share my pet's picture and story with Gulf Coast Veterinary Specialists.
Current Medications & Doses
Please list any current medications & doses.
Following the doctor’s examination, we will provide you with an estimate of fees. All professional fees are due at the time services are rendered, with a partial payment required to begin diagnostics, surgery, and/or treatment. We accept cash, check (with appropriate identification and check approval), major credit cards; or we can help you establish a payment arrangement if approved by Wells Fargo Health Advantage, or CareCredit, in advance of treatment. There will be a service charge for any check returned unpaid. We urge you to discuss all fees with the doctor before services are performed.
By checking this box, I agree to pay for all services rendered.
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