Client Information Form

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please see next page to add pet and medical history.

Financial Statement: Payment is due at the time of service rendered. Payment can be made in the form of cash, check, or credit card. At your request, we are happy to provide an estimate for services. If we need to proceed to collections for any account past due, the client is responsible for all costs including attorney fees. A $4.50 late charge will be added to all accounts in default at the end of each month. Client will be responsible for all fees incurred on any returned checks.

Cancellation Policy: Missed appointments and boarding reservations not cancelled 24 hours in advance are subject to a $25 service charge.

Please indicate weeks, months, years

SpayedNeuteredIntact

PATIENT MEDICAL HISTORY (All animals must be current on vaccinations if being dropped off/ boarded or they will be given at owners expense)

Thunderstorm AxietyHuman AggressionAnimal Aggression

Please indicate weeks, months, years

SpayedNeuteredIntact

PATIENT MEDICAL HISTORY (All animals must be current on vaccinations if being dropped off/ boarded or they will be given at owners expense)

Thunderstorm AxietyHuman AggressionAnimal Aggression

Please indicate weeks, months, years

SpayedNeuteredIntact

PATIENT MEDICAL HISTORY (All animals must be current on vaccinations if being dropped off/ boarded or they will be given at owners expense)

Thunderstorm AxietyHuman AggressionAnimal Aggression

Patient and Client Information:

Primary Contact

Secondary Contact

Pet #1