New Client Form

New Client Form

Thurman Veterinary Center
Client Information
Date *

Month Day Year
Date
Name of owner *

First Name Last Name
Name of secondary owner (if applicable)

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Primary Phone Number *
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email Address (we only us this for client/practice communication): *
example@example.com
Owners date of birth *

Month Day Year
This is required because certain medications require owner DOB to fill.
Pet Information
Name of Pet
Is your pet a dog, cat, or farm/large animal?
What breed is your pet?
Ex: Golden Retriever (dog). Domestic short hair (cat)
What color is your pet?
What is your pets date of birth? If you do not know DOB, how old is your pet?
Is your pet male or female?
Has your pet been spayed or neutered?

Select drop down to add another pet.
Additional Pet Information
Name of Pet
Is your pet a dog, cat, or farm/large animal?
What breed is your pet?
Ex: Golden Retriever (dog). Domestic short hair (cat)
What color is your pet?
What is your pets date of birth? If you do not know DOB, how old is your pet?
Is your pet male or female?
Is your pet spayed or neutered?

Select drop down to add another pet.
Additional pet Information
Name of pet
Is your pet a dog, cat, or farm/large animal?
What breed is your pet?
Ex: Golden Retriever (dog). Domestic short hair (cat)
What color is your pet?
What is your pets date of birth? If you do not know DOB, how old is your pet?
Is your pet male or female?
Is your pet spayed or neutered?

Office Policies and Information
Office Policies and Information
How to Cancel Your Appointment: If you need to cancel your appointment, please call us at 661-589-9900 during our normal business hours. If necessary, you may leave a detailed voicemail message. We will return your call as soon as possible. Late

Cancellations/No-Shows: A cancellation is considered late when the appointment is cancelled less than 24 hours for Doctors’ appointments and 72 hours for surgeries/Dentals.A no show is when a patient misses an appointment without cancelling. In either case,you will be charged a fee of $25 for Doctors’ appointments and $100 for surgical appointments.

Annual exam/Doctor exam/Drop off exam: Are any type of appointment that requires client/patient to see the Doctor. It is a state requirement that each pet have a yearly up to date exam on file in order to receive vaccinations, have medications prescribed by our office or to approve online prescriptions.

Medications & Foods: All of our medications and foods are by prescription only and must be prescribed by a Veterinarian. State laws also prohibit a veterinarian from filling a prescription ordered by another veterinarian. By law I, as a client, have the right to request a written prescription at no charge.

Social Media: I waive my patient confidentiality disclosure if I, the aforementioned client or an agent acting on their behalf, reach out to Thurman Veterinary Center via social media (including, but not limited to Facebook, Instagram, and Yelp).

By signing this I authorize any records to be shared with any specialist, other veterinary office, or any animal service based facility per my request, or the recommendation of this office. I hereby authorize the veterinarian to examine, prescribe for, and/or treat the above described pet. I assume responsibility for all charges incurred in the care of the animal. I also understand that ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED.
Signature:

Clear
Date

Month Day Year
Date
Please upload any previous veterinary records or vaccination history here:

Cancel of
Should be Empty:

New Client Form

Client Information

Pet Information

Additional Pet Information

Additional pet Information

Office Policies and Information