Veterinary New Client Enrollment Form

  • Welcome To Our Practice

    Dr. Crystal Gill, Dr. Kelcy Walker, Dr. Jacque Murray, Dr. Kristie Dixon, Dr. Kelsie Speiser, Dr. Katie Schwartz
  • Have you ever brought a pet to Gem City Veterinary Services before?*
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  • How Would You Prefer To Be Contacted?*
  • Is There a Spouse/Partner/Family Member Who Should Be Listed On Your Account?
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  • Is there anyone else (besides above listed contacts) who should be listed on your account, who has ongoing permission to make medical decisions for your pet(s)?
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  • How did you hear about us?*
  • Species*

  • Sex*
  • Is Your Pet Microchipped?*
  • Do You Already Have a Scheduled Appointment?*
  • Appointment Date
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  • Do You Have More Than One Pet At Home?
  • Species*

  • Sex*
  • Is Your Pet Microchipped?*
  • Do you have more than 2 pets at home?
  • Species*

  • Sex*
  • Is Your Pet Microchipped?*
  • Species*

  • Sex*
  • Is Your Pet Microchipped?*

  • This form supports telling us about 4 pets in your home. If you have more than 4 pets, please let our office know and we will happily collect information to add them to your account. 

  • Client Policies and Procedures

    We want you to be aware of and understand the following policies and procedures for all clients.
  • We Love Social Media! Do we have your permission to post pictures of your pet(s), you and your pet(s) and/or your pet(s) and our team on Facebook, Instagram, Twitter, www.gemcityvet.com and any other marketing and/or other social media outlets we may choose to use?*

  • FINANCIAL POLICY:

    Our office accepts Visa, Mastercard, Discover, and American Express. We also accept cash and checks.

    In addition, we also offer 3rd party financing options for our clients via Care Credit and Scratchpay. Applying is easy and only takes about 30 seconds at carecredit.com or scratchpay.com

    As financing options are offered, we cannot offer additional in-house payment plans for our services. Clients needing additional financial support are encouraged to apply for Care Credit with a co-signer. Locally, ACPE FCU offers personal loans for pet care.

    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. Client will be responsible for a 1.5% monthly finance charge on accounts over 30 days and any collection and/or legal fees on accounts over 90 days. Your signature below indicates your agreement with these policies.

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