New Client Information Form

New Client Information Form

Thank you for choosing German Village Veterinary Hospital for your pet's needs. Please fill out our new client registration form before your first appointment.
Primary Pet Parent
Name *

First Name Last Name
Drivers License # or Date of Birth *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Email *
example@example.com
Secondary Pet Parent
Name

First Name Last Name
Relationship to Primary
Phone Number
Email
example@example.com
Social Media Permission
Do we have your permission to use pictures of your pet that we take on GVVH social media pages, website, or in promotional material? *

Yes No
If your pet has their own social media account, please share their handle:
Referral
How did you hear about us? *
If another client told you about us, please give us their name so we can give them a $10 credit:
Payment and Cancellation Policy
Our office accepts Visa, Mastercard, Discover, Care Credit, and Cash. We do NOT accept Amex. We accept checks after the first visit and with verification of valid drivers license or other ID at time of payment.

Additionally, use of Care Credit requires that the card be present every time and that two forms of identification are verified. We appreciate your understanding of our desire to protect your account/identity.

Full payment is due at the time of service. This includes any charges/fees agreed to by my authorized proxy. Our team is happy to provide any client with a written treatment plan prior to services being rendered.

We require 24-hour notice of cancelling or changing your appointment. If you give less than 24 hours’notice, we will charge a $51 fee. If you cancel a surgery/dental with less than 3 days’ notice, a non-
refundable $200 deposit will be required before you can schedule another surgery date.

Your signature below indicates your agreement with these policies.
Date *

Month Day Year
Date
Signature *

Clear
Should be Empty:

New Client Information Form

Primary Pet Parent

Secondary Pet Parent

Social Media Permission

Referral

Payment and Cancellation Policy