New Client - Family/Client Contact Information
Welcome to Highland Veterinary Clinic! In order to provide customized services for your family and your pet, the New Client Form is used to set up your communications preferences, provide accurate information about your new pet patient, discloses our financial policies to you in advance, and advises us on how to best input your information to serve you and your pet. The Veterinary Client Services Representatives and Practice Managers are the only people who sees your new client form, and once signed, it is scanned and uploaded to a file attachment area of your chart but the form is not shared with any third parties beyond Highland Veterinary Clinic. Completion to the best of your ability greatly decreases new client wait time during the appointment process. Please do not list a driver's license number nor any social security numbers on this form, but bring along a state ID for your protection and identification.
Email address *
Name (Last Name, First Name) *
Your answer
Would you like to list a Spouse, Significant Other, Relative or Friend on the account? Secondary account holders must be over 18 years of age. Please indicate their relationship to you.
Your answer
Street Address, City, State, & Zip Code *
Your answer
Primary Phone Number (+ Area Code) *
Your answer
Is the primary phone a *
Second Account Holder's Area Code + Cell (for ER or urgent purposes)
Your answer
Would you like for us to communicate with you by text or provide text reminders/notices?
Do we have permission to use your email address to provide you with access to your pet's Electronic Medical Record (PetSites) and to fulfill prescriptions via our Online Pharmacy? *
Alternative Preferred E-mail
Your answer
Household health and safety is important to us: Are there any other human or pet medical alerts, dangerous allergies, behavioral health concerns, or personal safety preferences that you wish to have noted on your family’s account or pet patient's chart? For example, is anyone allergic to latex, food or treats that might be used in the hospital--i.e. peanut butter--common drugs or medications, have special environmental needs, have compromised immune systems, have special privacy concerns etc. If so please briefly describe if you are comfortable so we can safeguard your family and your pet's experience. If none, simply type "None" *
Your answer
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