New Hours

Mon, Tues, Thurs, and Fri 7:30am – 6:00pm
Wed and Sat 8:00am-12:00pm
Sun closed

Online Form

New Client Registration Town and Country Veterinary Hospital

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

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New Client Registration

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.

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Registration

Owner Name *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Mobile Phone

Emergency Contact

Phone Number

About our visit today

What brings you in today? *

How long has your pet been experiencing this issue? *

Is your pet current on all vaccinations? *

If no please list below all vaccinations needed

Is your pet on any Flea/tick or heartworm preventative? *

Any Vomiting or Diarrhea? *

If yes, for how long?

Any Coughing or Sneezing? *

If yes, for how long?

Any itching? *

If yes, for how long?

Any limping? *

If yes, for how long?

Which leg is your pet limping on? *

Have you noticed a decline in your pets activity level or any changes in behavior? *

If yes, please explain

Do you have any other issues or concerns that were not listed above that you would like to talk to your doctor or Technician about today?

What does your pet eat? *

How much/ and how often? *

Does your pet get table scrapes or human food? *

How often? *

Have you noticed your pet drinking more water than usual? *

Please List all current medications, supplements, or Over the Counter medications your pet is currently taking. Please included dosages:

How did you hear about us? *

Online
Referral
Sign
Other

If referred, by whom?

If other, please specify

How many Pets in the home?

Number of dogs

Number of cats

Number of other pets

Pet's Medical History

Name of Pet *

Type of pet *

Breed *

Color *

Date of Birth *

Sex *

Male
Female
Spayed/Neuter
Unaltered

Vaccination History: Type and date given:

Please select any of the following symptoms you have noticed in your pet:

Behavior Problems
Bleeding gums
Breathing Problems
Coughing
Diarrhea
Eye Bulging and bloodshot
Gagging
Lack of Appetite
Limping
Loss of Balance
Scooting
Scratching
Seems Depressed
Shaking Head
Sneezing
Thirst and/or Urination Increase
Vomiting
Weakness
Other

Other *

Pet’s current medications/Supplements: Please list name and dosage and frequency given:

Describe your pet’s diet: what do they eat, how often, and how much

Authorization

I, hereby, authorize the Veterinarian to examine, prescribe for, or treat the above-described pet. I assume full responsibility for all charges incurred in the care this animal. I also understand that these charges are to be paid in full at the time of release and that a deposit may be required for some surgeries, procedures, treatments, and other services provided for this animal. *

I have read and understand

Signature of Owner *

Date *

Book An Appointment

We serve Belvidere, Cowan, Decherd, Estill Springs, Huntland, Tullahoma, Winchester and surrounding areas. Book an appointment by clicking the button below.

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Have a question?

Get in touch! Complete our online form, and we will be in touch with you shortly. If you are dealing with an emergency during business hours, please call us directly at 931-967-3666.

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Location

44 AEDC Road
Winchester, TN 37398

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Location

44 AEDC Road
Winchester, TN 37398

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Contact Information

Phone: 931-967-3666
Email: townandcountryvetwinchester@gmail.com



Contact Information

Phone: 931-967-3666
Email: townandcountryvetwinchester@gmail.com

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Hours

Mon, Tues, Thurs, and Fri 7:30am – 6:00pm
Wed and Sat 8:00am – 12:00pm
Closed on Sundays

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Hours

Mon, Tues, Thurs, and Fri 7:30am – 5:00pm
Wed and Sat 8:00am – 12:00pm
Closed on Sundays

Name *

First

Last

Email *

Phone

How can we help you? *

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