New Client Form

Please fill out this form as completely
and accurately as possible so we can get to
know you and your pet before your visit.

We require a reservation deposit of $64.00 for new clients, which will be applied toward the cost of the exam. This deposit is refundable if the appointment is canceled at least 48 hours in advance.

Full Name*

Last Name*

Email*

Primary Phone*

Secondary Phone

Address

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name

Species (dog, cat, etc)

Breed

Age/Date of Birth

Sex
MaleNeutered MaleFemaleNeutered Female

Does your pet have a microchip identification? *

YesNo

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your Pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your Pet. We accept Cash, Visa, MasterCard, Discover, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy

New Client Form

Please fill out this form as completely
and accurately as possible so we can get to
know you and your pet before your visit.

We require a reservation deposit of $64.00 for new clients, which will be applied toward the cost of the exam. This deposit is refundable if the appointment is canceled at least 48 hours in advance.

About Us

Services

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.

We require a reservation deposit of $64.00 for new clients, which will be applied toward the cost of the exam. This deposit is refundable if the appointment is canceled at least 48 hours in advance.

Please fill out this form as completely
and accurately as possible so we can get to
know you and your pet before your visit.