New Client Welcome Form

New Client Welcome Form

160 Corporate Blvd., Indian Trail, NC (704) 821-7040 Fax: (704) 821-4692
Welcome to the Indian Trail Animal Hospital family - we are glad you are here!

At Indian Trail Animal Hospital, you will experience high quality up-to-date pet healthcare delivered by a caring and compassionate team that makes partnering with you to improve the health of your pet and the strength of your bond our highest priority.

Our mission is to care for your family by nurturing the human-animal bond. Please let us know how we can fulfill our mission for your family.

Our Values:
- Genuine relationships with your family and pets
- Your time and commitment to your pets
- The application of modern medicine to better serve your family
- Training for our entire medical team, and sharing our knowledge with you
Thank you for taking the time to fill this form out as completely and accurately as possible.
Are you the pet's:

OwnerCo-OwnerResponsible Party
Owner's Name:
Owner's Address
Owner's City/State/Zip
Owner's Home Phone
Owner's Cell Phone
Owner's Email
example@example.com
Co-Owner or Responsible Party's name and relationship to owner:
Co-Owner or Responsible Party's Address (if different from owner's)
Co-Owner or Responsible Party's City/State/Zip
Co-Owner or Responsible Party's Home Phone
Co-Owner or Responsible Party's Cell Phone
Co-Owner or Responsible Party's Email
example@example.com
If other individuals are permitted to make medical and/or financial decisions for your pets, please list their names and contact information here:
What is your contact preference? (please mark below for each method either 1, 2, and 3 in order from most preferred to least preferred, 1 being most preferred)
Phone Call (rank by typing 1, 2 or 3)
Text Message (rank by typing 1, 2 or 3)
E-mail (rank by typing 1, 2 or 3)
How did you hear about us?
Should we share a referral discount with any specific person?
I ASSUME RESPONSIBILITY FOR ALL CHARGES INCURREDINTHE CARE OR 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. I ALSO GRANT INDIAN TRAIL ANIMAL HOSPITAL PERMISSION TO POST MY PET'S PICTURE, STORY, AND MEDICAL INFORMATION ON SOCIAL MEDIA.
Owner or Responsible Party Signature

Clear
Date

MonthDayYear
Date
Printed Name
Should be Empty: