New Client Form

Owner's Name:

Address:

Pet Health History

Last Vet Visit & Reason for Visit or Anything we need to be aware of:

I/we hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I/We assume responsibility for all charges incurred for the care of the animal. I also understand that all professional fees are due at the time services are rendered. I/We will be paying by Check Cash, Visa, Debit, Master Card or Discover (Please Circle your preference).