New Client Form

Name

First Name Last Name

Email

example@example.com

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

Pet #1

Name Age Breed

Pet #2

Name Age Breed

Pet #3

Name Age Breed

Referral Policy It is our goal, at Community Pet Hospital, to ensure timely communication with your primary care veterinarian (if you have one). Who is your regular veterinarian?

Appointment Cancellation Policy
Community Pet Hospital enforces an Appointment Cancellation Policy. In the event that you are unable to honor your scheduled appointment, we require that you provide us with at least 24 hours notice. Clients who have failed to honor the
appointment cancellation policy may be subject to deposit requirements at scheduling.

Multiple Pet Appointments
In order to provide individualized service to each pet, Community Pet Hospital may impose a limit on the number of pets from the same family our doctors can see in one appointment. A deposit is required for all multiple pet appointments at scheduling. The deposit is non-refundable if you fail to arrive for your scheduled appointment.

Financial Policy
•Payment is due at the time service is provided.
•Our office accepts cash, Mastercard, Visa, Discover, AMEX, and Care Credit. We also offer financing through ScratchPay.
•A deposit is required for pets hospitalized for extended treatment.
•A deposit is required for all multiple pet appointments.
•Emergency exam fees will be collected prior to seeing the veterinarian.
•All incurred charges are the responsibility of the client.
•Past due accounts are subject to cost of collection (up to 50% of outstanding balance), including attorney fees.
•Charges may be incurred for missed appointments cancelled without 24 hours advance notice.

What method of communication for updates about your pet, such as lab results, do you prefer?

phone email

We occasionally feature pets and their stories on social media. We always maintain client privacy in these posts. If you would prefer to not have your pet featured, please opt out of social media.

Opt Out

Signature

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