FMC- New Client Enrollment Form

  • Welcome!

    Thank you for choosing The Feline Medical Center for your cat's needs. Please fill out our new client/patient registration form in its entirety to ensure we can provide you and your pet with the best possible care.
  • Have you ever brought a cat to The Feline Medical Center 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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  • In case of emergency...

  • 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?*
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  • Sex*
  • Is Your Cat Microchipped?*
  • Do You Already Have a Scheduled Appointment?*
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  • Do You Have More Than One Pet At Home?*
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  • Sex*
  • Is Your Pet Microchipped?*
  • Do you have more than 2 pets at home?*
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  • Sex*
  • Is Your Pet Microchipped?*
  • Do you have more than 3 pets at home?*
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  • 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.FelineMedCenter.com and any other marketing and/or other social media outlets we may choose to use? No identifying information will be used.*
  • The Feline Medical Center uses email, text and calls for communications regarding our patient's reminders for health care needs. Do we have your permission to contact you via email, text and/or calls regarding these reminders?*

  • FINANCIAL POLICY:

    Our office only accepts Visa, Mastercard, Discover, and American Express. We DO NOT accept cash or check payments.

    In addition, we also offer several 3rd party financing options for our clients via Care Credit. We accept a variety of Care Credit plans based on the total transaction amount for your pet. Care Credit requires that payment only be made for services as they are rendered, we cannot charge services to your account in advance. Therefore, Care Credit cannot be used for PAW plan services. We appreciate your understanding of our desire to protect your account/identity.

    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.

    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 90 days and any collection and/or legal fees on accounts over 90 days. Your signature below indicates your agreement with these policies.

  • TREATMENT CONSENT:

    By signing this document, I declare I am the lawful owner of all listed pets and all information is true and correct to the best of my knowledge. I hereby authorize the veterinarian(s) of The Feline Medical Center to examine, prescribe for and/or treat my pet(s) to the best of their abilities. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment or hospitalization. I acknowledge that medical information will not be released to anyone not indicated on this form without my express verbal and/or written permission with the exception of another veterinary facility.

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