New Client Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.
  • Owner's Name

  • Co-owner's Name & Contact #

  • Pet Information

  • Date Format: MM slash DD slash YYYY
  • Would you like us to contact you to schedule an appointment?
  • Section Break

  • Payment IN FULL for ALL services is due at the time of service. We do NOT routinely bill clients for services rendered. An "Ill-Pet" Examination or "Well Pet" office call (vaccines etc.) for dogs or cats during normal business hours is $50 currently; ANY additional tests, treatments, or medications are additional costs. Prescriptions are non-refundable by law. We accept Cash, Personal Checks with identification, VISA, Master Charge, American Express, Discover Card, and CareCredit.Deposits are required before hospitalizing any ill patient; the balance for all fees is then due when the services are completed. Unpaid accounts are assessed a 1.5% finance charge per month ($2 minimum fee). Returned checks are assessed a $20 fee (or the maximum allowed by law). As our client, you agree to pay for any collection or legal costs incurred in the collection of any debt (up to 33.33% of the total fees). Any debt upon being 10 days overdue may be turned over to a collection agency. You also give us permission to release records to other veterinary hospitals, boarding or grooming facilities or other animal care facilities when requested by you (or any agent of yours) [whether by phone, FAX, email, or in writing] in the future. You also give us permission to use images or video of your pet for online sites such as our business web site, web search engines, and social media such as Facebook. No personally identifiable information shall be released in such a use.