New Client Form New Client Form Name * First Last * Last Email * Primary Phone * Secondary Phone Pet's Name * Species * Breed * Color * Approximate Age / Date of Birth * Sex * Male Neutered male Female Spayed female Does your pet have a microchip identification? * Yes No Does your pet have insurance? If so, who is their provider? * Do you have a second pet? * Yes No How did you find out about our hospital? if you were referred by someone, who should we thank? 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 and estimate form, and 2) Regarding surgical procedures and specialized treatments, we reserve the right to ask for a 50% deposit upon booking. 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. Captcha Submit If you are human, leave this field blank.
