New Client Form printable pdf download

New Client Form

Owner’s Name:_______________________________

Pet #1 Name:__________________________ DOB/ Age:____________

Partner Name:_______________________________

Species:________________________ Breed:______________________

Address:____________________________________

Color:_______________ Sex:_________ Spayed/Neutered?__________

City, State, Zip:_______________________________

Medications/Medical Conditions:________________________________

Home Phone:________________________________

Pet #2 Name:_________________________ DOB/Age:_______________

Cell Phone:__________________________________

Species:________________________ Breed:_______________________

Partner Cell Phone:___________________________

Color:________________ Sex:_________ Spayed/Neutered?___________

E-mail Address:______________________________

Medications/Medical Conditions:_________________________________

How did you hear about us? Circle One:

Sign/Drive By Website Facebook

Internet

Friend Other:____________________

ALL payments are due at the time services are rendered. All returned checks will be assessed a $20 returned check fee. A service

charge of 1.5% per month- an annual percentage rate of 18%- will be applied to any unpaid balance. In the case of default payment,

I promise to pay any legal interest on the balance due, together with any collection costs and reasonable attorney fees incurred to

effect collection of this account or future outstanding accounts.

To prevent the spread of infectious disease and parasites, hospitalized and boarded animals must be current on all vaccinations and

free of internal and external parasites. I authorize the doctor to provide vaccines and parasite control as needed for my pet.

Signature:__________________________________________________________ Date:__________________________

New Client Form