New Client Form

Matthews Vet Services New Client Form

To ensure we have all necessary information, please email prior medical records to Info@matthewsvetservices.com or attached them to this form.
Owner's Name

First NameLast Name
Owner's Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Specific Driving Directions (gate code, etc)
Is your physical address the same as your mailing address?
Owner's Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Account owner must be over 18 years of age.

As account owner, you assume financial & medical responsibility for the patients listed on your account. We reserve the right to require proof of ID
Owner's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearMM-DD-YYYY
Owner's Contact Number
Format: 000-000-0000.
Owner's E-mail
example@example.com
Owner's Driver's License Number
Ex: 12345678
Owner's Account Profile Picture

Browse Files
Send us the cutest picture of all your pets so we can add it as your account profile photo! Cancelof
How did you hear about MVS?
How did you hear about MVS

Other
Who referred you?

First NameLast Name
Who referred you?
Owner's Preferred Method of Contact
Do you consent to MVS sharing your pet’s photo and/or story?
Pet’s Name
Species
Breed
Color(s)
Pet's Sex
Age of Pet
Pet’s Date of Birth (If Known)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Pet's Microchip Number
Leave blank if your pet is not microchipped.
Pet's Location
Boarding Facility Name
Boarding Facility Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Boarding Facility Phone Number

Area CodePhone Number
Pet's Records

Browse Files
Please upload or email us the records from your pet's previous Veterinarian Cancelof
Pet's Profile Picture

Browse Files
We would love to add a picture of your pet to their chart! Cancelof
Pet's Weight in Pounds
Can be estimated or a range (Ex: 45-55lb
Does this pet have any behavioral needs we should be aware of? (PLEASE SELECT ALL THAT APPLY)

Other
Main Concern for Appointment
Pet’s Pertinent Medical History and Current Medications
Do you have a second pet that needs to be evaluated?
Second Pet’s Name
Second Pet's Species
Second Pet's Breed
Second Pet's Color(s)
Second Pet's Sex
2nd Pet’s Date of Birth (If Known)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age of Second Pet
Second Pet's Microchip Number
Leave blank if your pet is not microchipped.
Second Pet's Location
Second Pet's Boarding Facility Name
Second Pet's Boarding Facility Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Second Pet's Boarding Facility Phone Number

Area CodePhone Number
Second Pet's Records

Browse Files
Please upload or email us the records from your pet's previous Veterinarian Cancelof
Second Pet's Profile Picture

Browse Files
We would love to add a picture of your second pet to their chart! Cancelof
Second Pet's Weight in Pounds
Can be estimated or a range (Ex: 35-45 lbs)
Does this 2nd pet have any behavioral needs we should be aware of? (PLEASE SELECT ALL THAT APPLY)

Other
Main Concern for Second Pet's Appointment
Second Pet’s Pertinent Medical History and Current Medications
Have you already received an estimate from us?
Do you already have an appointment scheduled with us?

Other
Date of Appointment (scheduled or offered)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearAppointment Date
Additional Concerns/Requests /Notes
What will be your preferred method of payment for each invoice?

Other
MVS Cancellation Policy

If your appointment is canceled or rescheduled with insufficient notice, a deposit in the amount of your trip charge will be required prior to scheduling another appointment. Sufficient notice is considered before 5pm, 2 business days prior to your appointment. If your rescheduled appointment is not canceled, or is rescheduled with sufficient notice, the trip charge deposit will be applied to your next invoice. However, if there is a 2nd insufficient-notice cancellation/rescheduling, the trip charge deposit will be converted into a non-refundable cancellation fee.
By initialing below you signify an understanding and acceptance of our Cancellation Policy as listed above.
Payment will be expected at time of service.
If you want to include more pets on your file, even if they don't need to be seen during the initial appointment, please submit the Multiple Pets Form (https://form.jotform.com/223114838633152) after you submit the New Client Form.
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Matthews Vet Services New Client Form

Account owner must be over 18 years of age.