IPVH Client Information/Policy Form

Indy Paws Veterinary Hospital New/Updated Client Information Form

Please fill in the form below
Client Name:*

First NameLast Name
Primary Client Date of Birth:*

MonthDayYear
Date
Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number:*

Area CodePhone Number
Email*
example@example.com
What is your preferred method of communication with our office?*

TextCallEmailMailOther
Would you like to be contacted to schedule an appointment for your pet?

YesNo, not at this time.
Primary Client Driver's License or SSN:
Co-Owner (if applicable)

First NameLast Name
Alternate Contact

Area CodePhone Number
How did you hear about us? (Give a name if a client referred you!)
Pet Information

Please fill out the questions below in as much detail as possible.

Pet Information*

	Pet 1	Pet 2	Pet 3
Name
Species, Breed
Birthday/Age
Color/Markings
Gender (Spay/Neuter)
Prior Veterinarian
Current medications
Important history

Policies and Release
Payment Policy

Payment is due in full at the time services are rendered. For your convenience, we accept all major credit cards, cash, CareCredit, and Scratchpay.

Failure to pay for any services rendered by Indy Paws Veterinary Hospital will result in client responsibility of any attorney fees or court costs incurred by the hospital.

Missed Appointments/Cancellations

In order to best serve you and prevent appointment delays, we request that you arrive within 5 minutes of your appointment time. If you are more than 5 minutes late, your appointment may be forfeited and we may request that you reschedule your appointment.

We understand that circumstances may come up that will make it necessary to cancel an appointment or a surgery. Missed appointments represent a loss to us, to you and your pet, and to other patients who could have been seen in the time set aside for you. Cancellations or rescheduling must be made at least 24 business hours before the scheduled appointment. If you do not give us that notice, we will require a non-refundable, deposit to schedule your next appointment and future appointments.

We require a deposit for all new client appointments to secure appointments. Deposits are applied toward the scheduled visit unless an additional cancellation should occur (ie: If you do not give us that notice, this initial deposit will be closed out as a final payment for the missed appointment). For surgical cancellations, a full, non-refundable, deposit of the low end of the estimate will be required for future scheduling.

Social Media Release

At Indy Paws Veterinary Hospital love our patients and clients, and enjoy sharing pictures and stories of your amazing pets!

By signing below, you authorize Indy Paws Veterinary Hospital and its representatives to share and post pictures of your pet(s) to Indy Paws Veterinary Hospital’s social media including, but not limited to, Facebook, Twitter, Instagram, for display, public relations, and marketing.

I acknowledge receipt of adequate consideration and waive the right to charge for use of my pictures and my name, or to inspect or approve the images prior to any form of usage. I understand the images may be modified to be used as design elements.
I certify that I am the owner or authorized agent of the pet(s) listed above. I am confirming that the information provided above is true to the best of my knowledge.

I understand and acknowledge receipt of the hospital policies and by signing below, I am agreeing to all policies listed above.
Signature*

Clear
Date:

MonthDayYearHourMinutesAM/PM Option
Please verify that you are human*
Should be Empty:

Indy Paws Veterinary Hospital New/Updated Client Information Form

Pet Information

Policies and Release