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New Client Form

Co-Owner Information

Co-Owner Name (first & last):

Co-Owner Phone Number:

Referral Information

Why did you choose our practice today?

Location

Website

Recommendation

Online search engine

Other

If you were referred by a client, what is their name?

Do we have your permission to allow clinics or other individuals access to your pet’s medical records?

Yes

No

Financial Policy

Thank you for choosing us to care for your loving pet. Our primary mission is to provide high-quality veterinary medical care in a clean and comfortable environment for you and your pet. An important part of the mission is making the cost of optimal care as easy and manageable for our clients as possible by offering several payment options. We require payment in full at the end of your pet's examination and/or at the time of discharge.

Payment Options
You can choose from

Cash, Check, Visa®, MasterCard®, American Express® or Discover Card®

Convenient Monthly Payment Plans from CareCredit®

Allow you to begin treatment today and pay over time for six months time with no interest
Available for any treatment amount

Can be used repeatedly - for your entire family - without having to reapply¹

Deposit & Billing
For some treatments or hospitalized care, a deposit may be required. Healthcare plans requiring comprehensive care of $500 or more will require a 50% deposit to begin your pet's treatment. We charge interest on all outstanding account balances older than 30 days. If you have an account 90 days past due, we may relinquish your balance owed to a collection agency.

Additional Policy Information
There is a $25 charge for returned checks. For clients with pet insurance, you are responsible for today’s charges and we are happy to provide you with the necessary documentation to submit a claim to your insurance carrier for reimbursement. If you have any questions, please do not hesitate to ask. We are here to provide the best veterinary care available for your pet.

By checking below, you agree to the foregoing terms of payment:

I acknowledge and agree to the policies listed above.