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 Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Specific Driving Directions (gate code, etc)
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
MM-DD-YYYY
Owner's Contact Number*
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*

Web Search/GoogleFriends/Family/NeighborReferral from another VeterinarianFacebookTwitter/Snapchat/other Social MediaFair, Festival or Event (ex: Barktober Fest)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?*

YesNo
Pet’s Name*
Species*
Breed*
Color(s)
Pet's Sex*
Age of Pet
Pet’s Date of Birth (If Known)

MonthDayYear
Date
Pet's Microchip Number
Leave blank if your pet is not microchipped.
Pet's Location*

Same as mailing addressPet is boarded
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
Main Concern for Appointment
Pet’s Pertinent Medical History and Current Medications
Do you have a second pet that needs to be evaluated?

YesNo
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
Date
Age of Second Pet
Second Pet's Microchip Number
Leave blank if your pet is not microchipped.
Second Pet's Location

Same as mailing addressPet is boarded at the same facility as the first petPet is boarded at a different boarding facility
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)
Main Concern for Second Pet's Appointment
Second Pet’s Pertinent Medical History and Current Medications
Have you already received an estimate from us?*

Yes, I received, reviewed and approved an estimateNo.
Do you already have an appointment scheduled with us?*

NoYesAn appointment date & time were offered but I haven't accepted or declined yet.Other
Date of Appointment (scheduled or offered)

MonthDayYear
Appointment Date
Additional Concerns/Requests /Notes
What will be your preferred method of payment for each invoice?

Credit/Debit CardCash/CheckOther
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.