Advanced Veterinary Care New Client Form

Client / Owner Name

First NameLast Name

Cell Phone

Area CodePhone Number

Communication Consent & Privacy

By agreeing to these terms and conditions you agree to receive automated marketing and informational SMS text messages from Advanced Veterinary Care. These messages may include appointment reminders, payment reminders, and other information related to your account or services with us. The frequency of these messages will vary depending on the purpose but in no case will you receive more than 10 per month. You may opt out of these messages at any time by unsubscribing or informing us directly at 303-635-6289. Standard message and data rates may apply. You acknowledge that you have read and understood our Terms and Conditions & Privacy Policy.

Home / Work Phone

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

We use this email to send you reminders for your pets medical care and vaccinations.

Spouse / Co-Owner

Spouse / Co-Owner Phone Number

please indicate if its a Cell, home or work number

How did you hear about us?

Do we have your permission to post pictures and/or videos of your pet on our social media or website?

Previous Veterinary Hospital to call for records:

Pets Name:

Birthday / Approx. Age:

Breed:

Color/Markings:

Any Known Allergies:

Any Previous Major Medical History:

Microchipped:

Species:

Sex:

Spayed/Neutered:

Has this pet traveled outside of Colorado in the last 6 months?

If so, where?

Does this pet currently take monthly parasite prevention?

Reason for visit, please explain if annual exam or sick pet?

If you have more additional pets, please provide the information below

Pets name, species, age, breed, color, chipped allergies, etc.

If your pet has insurance, please list below which insurance.