New Client Registration Form

Please correct the errors described below.

You and your pet's information will be held confidential. Please complete and answer all questions.

OWNER INFORMATION:

The pet owner who is responsible has to complete this registration (18 years or older).

PET INFORMATION: (please list all pets, whether or not they have an appointment today.)

Please list previous veterinary providers

What specific service(s) we provide attracted you to our hospital?

Did someone refer you to our hospital? If so, both you and your friend will receive $10.00 gift certificate for future services.

PAYMENTS AND PAYMENT POLICY:

**First time clients will be required to pay for the examination before any services can be rendered. No checks are allowed for first time clients.**

Payment in full are expected when service is rendered. Some procedures and services require full payment in advance or deposit. We provide many payment options for your convenience. We do not accept check payments on the first visit. Future payments by checks are verified by telecheck. A $49.00 NSF fee will be applied for any returned checks.

We accept CARE CREDIT: Six months no interest credit card based on approval. You can call or register online. 800-859-9975 or www.carecredit.com

Treatment Plans: We can provide you with a written estimate in advance and you can decide what level of care you want for your pets. (Please ask for a treatment plan BEFORE service is provided.)

Hospital Tour: If you would like a tour of the hospital please let us know.

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