New Client Form

Primary Contact Information

The following information is for the person who is considered the legal owner of the pet.
Please include area code.
Please include area code.
This is the method that we will use to reach out to you first.

Alternate Contact Information

You may authorize another person to make decisions about your pet's care. This person must be at least 18 years of age. This authorization does not relinquish your financial responsiblity for charges incurred on your behalf.
Please include area code.

Referral Information

Payment Policy

Payment is due at the time services are rendered. We accept cash, checks (with matching VA Driver's License or Military ID), Visa, MasterCard, American Express, Discover, and Care Credit. There will be a $100 fee for returned checks. In the event this account shall be in default and placed with a collection agency for collection, then the undersigned agree to pay all reasonable collection costs.
Please confirm your understanding and agreement to comply with our Payment Policy.

Publicity Release

From time to time we use photos of our patients for marketing purposes. If a name is used, it is only the first name of the pet and never the name of the pet's owner.
Please indicate if we are allowed to use pictures of your pet(s).