New Client Form
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1New
C lient
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Thank you for giving us the opportunity to care for your pet.
Please take the time to fill out this form completely.
Owner __________________________________Drivers License _____________________________
Co-Owner _______________________________ Drivers License ____________________________
Address________________________________________ City _________________ Zip___________
Home Phone _________________Cell Phone__________________ Work Phone________________
Co-Owner Cell Phone ____________________
Co-Owner Work Phone ___________________
E-mail address for website/ online store access: __________________________________________
(optional- and it will absolutely not be sold or shared):
PET HEALTH HISTORY
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1. Name of pet __________________________ Dog
Cat
Other
D.O.B._____________
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Breed ________________ Color ____________
Sex/ Altered? M
M/N
F
F/S
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2. Name of pet __________________________ Dog
Cat
Other
D.O.B._____________
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Breed ________________ Color ____________
Sex/ Altered? M
M/N
F
F/S
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3. Name of pet __________________________ Dog
Cat
Other
D.O.B._____________
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Breed ________________ Color ____________
Sex/ Altered? M
M/N
F
F/S
AUTHORIZATION
I hereby authorize the veterinarian to examine, prescribe for, and treat the above pet(s). I assume responsibility for
all charges incurred in the care of my pet. I also understand that these charges will be paid in full at the time of
services and that a deposit may be required for hospitalization or surgical treatment.
Your appointment time is important to you, your veterinarian, and to others who are in need of our services. If you
cannot keep your appointment for any reason, please call us 24 hours prior to your appointment time. If you do not
show for your appointment or fail to cancel in a timely manner, a fee may be applied to your account.
Signature___________________________________________Date________________
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