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New Client Form
First Name
Last Name
Spouse Name
Address
City
Zip
Clinic correspondence, patient healthcare, and appointment reminders are delivered via texts and/or emails. Please note if we may contact you via cell phone and/or email address.
Primary Phone
May we text?
Yes
No
Secondary Phone
May we text?
Yes
No
Email Address
May we use your email for communication purposes (ie: vaccine or appointment reminders)
Yes
No
Emergency Contact Person
Relationship
Contact Phone Number
Are you active military or a veteran? Please supply military ID - once this is supplied, we will notate your account in our system and you will be eligible for a 15% discount.
On occasion we take photographs of patients for social media purposes. Please check the box indicating if we may (or may not) use an image of your pet on our website, social media, or for educational or promotional purposes.
Pet Image Online
Yes, you may use an image of my pet online
No, please do not post images of my pet online
Signing below denotes that you have read and understand the following:
- Payment in full is due at the time of services rendered. We accept Cash, Credit/ Debit, Check, and care credit. - Pets that are brought in are required to be on a three foot leash or in a carrier. Animals on flex-leashes need to have the leash “locked” at no more than three feet.
Owner Signature (must be 18 yrs or older)
Date
Date Format: MM slash DD slash YYYY
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Contact Us
Meet Our Family
New Clients
Our Commitment
Take A Tour
What To Expect
Forms
My Pet
Pet Login
Profile
My Pet’s Medical Records
Feedback
Owner Education
Pet Health
Pet Health Library
Pet Health Checker
Interactive Animal
Breed Info
Videos
Our Services
Pet Services
Anesthesia and Patient Monitoring
Medical Services
Preventive Services
Surgical Services
Wellness and Vaccination Programs
Additional Services
VetSource