New Patient Form

WELCOME!

We are pleased to welcome you to our practice.  Please take a few minutes to fill out this form as completely as you can.

If you have questions, we’ll be glad to help you.  We look forward to working with you in maintaining your pet’s health.

Client Information
Address
Spouse Or Co-Owner of Pet
Pet Information
Type
Sex
Neutered/Spayed
Where did you obtain this pet?
For what purpose was this pet obtained?
Pet history - check all below that pet has received in the past year with dates, if possible
Describe any
Payment

We gladly prepare a written estimate of service fees if you desire (please ask our doctor or receptionist).  All professional fees are due at the time services are rendered.  In cases of extensive medical or surgical procedures where full payment may be difficult at discharge we accept major credit cards or can establish a payment arrangement if approved in advance of treatment.  There will be a service charge of any check returned unpaid.

To prevent the spread of infectious diseases, all hospitalized patients must be current on all vaccines and free from internal and external parasites. 

The signature below authorizes this level of preventive care and the appropriate charges will be assessed in the discharge invoice.

Sign above