New Client Form
Thank you for giving us the opportunity to care for your pet(s). So that we may become better acquainted, please complete the following.
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Email *
Owner Name *
Appointment Date    and  Time
Address (include city, state, zip) *
Phone number *
Secondary Phone number
Email Address *
Preferred Doctor *
Pet information Please include: Name, Breed, Age, Color, Sex, Spayed or Neutered, Previous illnesses/surgeries, Allergies to vaccines or medications. *
2nd Pet information Please include: Name, Breed, Age, Color, Sex, Spayed or Neutered, Previous illnesses/surgeries, Allergies to vaccines or medications.
3rd Pet information Please include: Name, Breed, Age, Color, Sex, Spayed or Neutered, Previous illnesses/surgeries, Allergies to vaccines or medications.
Where can we call for previous vet records? *
Cancellation Policy-  Due to the time-consuming nature of the work that we do, it is imperative that our doctors be able to devote undivided attention to each patient during their appointments. We make efforts every day to keep our practice running on time, and to avoid asking our clients to wait. We respect your time and we ask that you respect our time. The number of patients we can book in a day is limited. Since some days we experience a cancellations we have had to adopt the following policy. We require at least 24 hour notice to reschedule or cancel an appointment. If an appointment is cancelled with less than the 24 hour notice, or if you fail to show up, you will be charged for that appointment ($49.50). Frequent cancellations will result in your being required to pay in advance for an appointment scheduled at our clinic of $49.50. As a courtesy to our clients and in an effort to reduce the number of cancellations and missed appointments, we try to call and remind the day prior to the appointment. Failure to receive a reminder call does not negate the 24 hour cancellation policy. Thank you very much for your cooperation and consideration. Please check the box below acknowledging you understand *
Payment Policy- I accept full responsibility for the fees generated by services I authorize and I understand all fees are due and payable at time of service, or at the time the animal is released from the hospital. Any exception to this policy must be authorized prior to the performance of any service. We accept cash, checks, Master Card and Visa, American Express,  Discover, and Care Credit for your convenience.  I understand that certain treatment plans may require a 50% deposit before commencement of the treatment.  I understand and agree that if in the event of non-payment for services, it becomes necessary to file a lawsuit for collection, I will be responsible for costs and a reasonable attorney's fee.   *
I am the owner (or authorized agent) of the animal described and I give the doctor, her agents, employees and representatives authority to perform a physical examination, to recommend and prescribe treatment options including, but not limited to, laboratory testing, vaccines, medications, radiographs, and other therapies such as acupuncture, chiropractic, homeopathic and herbal medicine. I understand I will have the opportunity to accept or decline treatment recommendations verbally at the time of examination.  Further, I understand that I will have the opportunity to discuss a treatment program that may be beneficial to promote resolution of symptoms and to promote the overall health of my pet.   I understand that no guarantee of outcome can be made about any treatment plan presented. I take full responsibility for the treatment plan(s) I accept, and I will not hold the doctor or the practice responsible for results or complications that might arise due to the treatments accepted. This release will automatically serve as a release for any future examinations and/or treatments for which I schedule additional appointments. *
A copy of your responses will be emailed to the address you provided.
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