New Client Form

Save time during your appointment! Complete your required new client form online from any device at any time before your visit.

Get Started

New Client 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.

Owner's Name *

First

Last

Spouse/Co-Owner Name

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone

Co-Owner Cell Phone

Additional Phone

Employer's Name

Work Phone

Co-Owner Employer's Name

Work Phone

Emergency Contact Name *

Phone *

If recommended, who may we thank?

Authorization

BY SIGNING BELOW, I UNDERSTAND AND AGREE TO AUTHORIZE THE VETERINARIAN(S) TO EXAMINE, PRESCRIBE FOR, AND PROVIDE INITIAL DIAGNOSTICS FOR MY PET. I AM AWARE A DEPOSIT MAY BE REQUIRED PRIOR TO WORK UP. I AM 18 YEARS OLD OR OLDER AND AM ACCEPTING FINANCIAL RESPONSIBILITY FOR THIS PATIENT. I ASSUME FINANCIAL RESPONSIBILITY FOR ALL HOSPITAL CHARGES. I ASSUME RESPONSIBILITY FOR ALL FEES ASSOCIATED WITH THE COLLECTION OF ANY UNPAID BALANCES, INCLUDING $25.00 FOR RETURNED CHECKS. THE BALANCE WILL BE PAID IN FULL AT THE TIME OF DISCHARGE. A 1.5% FINANCE FEE WILL BE CHARGED EVERY 30 DAYS TO PAST-DUE ACCOUNTS. SHOULD WE HAVE TO FILE SUIT IN ANY COURT OF LAW TO COLLECT THE AMOUNT DUE, I AGREE TO PAY ALL ATTORNEY FEES AND COURT COSTS INCURRED IN ANY COLLECTION EFFORT FOR MY ACCOUNT. I ASSUME RESPONSIBILITY OF A NO SHOW FEE OF $50 IF I DO NOT CANCEL 24 HOURS BEFORE MY APPOINTMENT.

Signature *

Date *

Message

Call

Email Us

New Client Form

New Client Form

Authorization

Ready For A Visit?

Have Questions?

Location

Contact Information

Hours