Client Information Form

Name(Required)







Address(Required)















Preferred method of communication?(Required)


Secondary Account Holder

(This individual will have full authority to make decisions on treatments and can request pet’s records)

Name







Address















Emergency Contact

Name







How did you hear about us?






How much information do you want to be given about your pet’s health?(Required)



Pet Information (#1)

Species




Sex


Spayed or Neutered



Allergies


Pet Information (#2)

Species




Sex


Spayed or Neutered



Allergies


Pet Information (#3)

Species




Sex


Spayed or Neutered



Allergies


Payment

Payment is required at the time of service. For your convenience, we accept Mastercard, Visa, American Express, cash, or check (with a valid driver’s license). A deposit may be required for surgical procedures or hospitalization of your pet. Returned checks are subject to a $35.00 fee. By signing this document, you agree that you are responsible for payment of all services rendered and that if payment becomes past due, it is subject to an interest rate of 18%.


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