NEW CLIENT INFORMATION

Owner Name

First NameLast Name

Phone Number

eg 770-614-9060

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Spouse/Other

First NameLast Name

Spouse/Other Phone Number

How did you hear about us?

If you were referred, who may we thank?

Pet's Name

Pet's Date of Birth or Approximate Age

Species

Other

Sex

Breed

Color

Date of most recent vaccines and where were they given?

Is your pet on any routine medications? If so what?

Is your pet on flea or heartworm prevention? If so what?

To your knowledge, does your pet have any allergies?

Pet Photograph Release

We enjoy sharing photos and videos of our patients and their families on social media and occasionally on print materials, advertising, and signage for the hospital. However, we will never do so without your consent.

Hog Mountain Animal Hospital maintains an Internet (website, Facebook page, etc.) and public relations (flyers, mailings, etc.) presence for purposes including marketing and client education. Part of this presence includes posting and photographs of our practice and its daily workings. Therefore, we may be interested in using images of your pet(s) as part of the effort to maintain, expand, and educate the public about our business and services. We would refer to pets by call name only, if at all.

Do you grant permission for Hog Mountain Animal Hospital to take photos of your pet(s) and use them for any lawful purpose, including, publicity purposes, illustration, advertising, and web/social media content?

Payment Policy

Payment is due at the time of service. We accept cash, checks, care credit, Visa, MasterCard, Discover, American Express, and debit cards. All unpaid balances will incur a 1.5% finance charge at the end of each month. All returned checks will incur a $35.00 service charge.

Medical and Surgical Release

By submitting this online form, I hereby consent and authorize Dr. Martinez, Dr. Addante, or any other doctor employed by Hog Mountain Animal Hospital to receive, prescribe for, and treat my pet/pets.

Client Code Of Conduct Policy

Hog Mountain Animal Hospital strives to provide a welcoming and safe environment for our staff, clients, and patients. This allows us to ensure that we facilitate an environment of trust and respect for all people and pets. As such, the following behaviors displayed in our clinic and on our premises are strictly prohibited:

Yelling or screaming at any employee for any reason
Profanity
Bullying, cyberbullying, libel, slander, defamation of character, or any combination thereof
Any act or threat of violence
Verbal, physical, or sexual harassment
Intimidation tactics
Failure to comply with requests from our staff, such as leashing/restraining your pet
Demonstrating belligerent manner suggestive of being under the influence of drugs or alcohol

We understand that emotions can run high when pets are ill or injured. At the same time, we cannot sacrifice our mental health and emotional well-being to help pets belonging to owners who are abusive to us and affect how we continue to perform a job that we love.

We hope that our clients will support this Code of Conduct and contribute to a peaceful, professional environment in which we can safely care for the pets in our community.

Boarding Policy

We offer boarding facilities for your pets. For your pet's protection, we do require that all boarders be up to date on core vaccines and labs, including rabies, DHPP, bordetella, and an intestinal parasite exam for dogs, and rabies and FVRCP for cats. In the event that your pet should become ill while under our care, we will take all necessary emergency action. We will make every effort to contact you. We ask that you leave an emergency phone number each time that you board your pet. Boarding charges begin on the day that the pet is brought in and continue each day until the day of pick-up. If the pet is picked up before noon or is being groomed/bathed on that day, there will be no boarding charge on the last day. If your pet is seen by a doctor, we may call you to discuss the exam unless you specify otherwise. If any fleas, ticks, or other parasites are observed, that pet will be treated for these parasites at the owner's expense.

I hereby agree to the above Payment Policy, Medical and Surgical Release Policy, Client Code Of Conduct Policy, and Boarding Policy. I will not hold Hog Mountain Animal Hospital, the veterinarians, or any staff member liable for any complications that may arise.

Signature

Signing this form means you agree to the above policies