New Client Paperwork

"*" indicates required fields

Owners Name*

Spouse

Hidden

Address*

Street Address*

City*

Zip*

Main Phone (this will be the number that reminders are received on):*

Spouse Phone

Work Phone

Email Address*

Employer Name

Employer Phone Number

ALL FEES ARE DUE UPON COMPLETION OF SERVICES

I hereby authorize the examination, prescription for, and/or treatment of my pet(s). I assume responsibility for all charge incurred in the care of this/these pet(s). I agree to pay all fees for all services rendered at the time the pet(s) is/are released from our care. Past due invoices are subject to an annual percentage rate of 18%. I understand a $30.00 service fee will assessed for each non-sufficient fund check.

Acceptance:*

I acknowledge and agree to the terms and conditions of service.

Agreed To Pay