New Client Form
WellHaven Bozeman Pet Hospital & Urgent Care
At Bozeman Pet Hospital, our dedicated and passionate staff strive to provide flexible, individualized care to patients and clients seven days a week. We build our client relationships on respect and trust through honest communication.
Your Information
Primary Name on Account
*
First Name
Last Name
Email
*
example@example.com
Primary Phone Number
*
Please enter a valid phone number.
Additional Phone Number
Please enter a valid phone number.
Secondary Name on Account
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pet Information
Pet's Name
*
Pet's Age
*
Pet's Species
*
Canine
Feline
Pocket Pet
Pet's Breed
*
Pet's Sex
*
Female
Spayed Female
Male
Neutered Male
History of illness or other concerns ?
Previous Veterinary Clinic or Shelter Facility
*
This information is used to obtain your pet's medical records.
Do you have an additional pet?
*
Yes
No
Pet's Name
*
Pet's Age
*
Pet's Species
*
Canine
Feline
Pocket Pet
Pet's Breed
*
Pet's Sex
*
Female
Spayed Female
Male
Neutered Male
History of illness or other concerns ?
Previous Veterinary Clinic or Shelter Facility
*
This information is used to obtain your pet's medical records.
Do you have an additional pet?
*
Yes
No
Pet's Name
*
Pet's Age
*
Pet's Species
*
Canine
Feline
Pocket Pet
Pet's Breed
*
Pet's Sex
*
Female
Spayed Female
Male
Neutered Male
History of illness or other concerns ?
Previous Veterinary Clinic or Shelter Facility
*
This information is used to obtain your pet's medical records.
Do you have an additional pet?
*
Yes
No
Pet's Name
*
Pet's Age
*
Pet's Species
*
Canine
Feline
Pocket Pet
Pet's Breed
*
Pet's Sex
*
Female
Spayed Female
Male
Neutered Male
History of illness or other concerns ?
Previous Veterinary Clinic or Shelter Facility
*
This information is used to obtain your pet's medical records.
Do you have an additional pet?
*
Yes
No
Other Pet's Basic Information
Social Media
This information is used to obtain permission to use photos of your pet(s) and/or tag you in photos we post.
Are we allowed to post photos of your pet(s)?
Yes
No
Your Instagram handle
If you would like us to follow/tag you.
Your Facebook Handle
If you would like us to follow/tag you.
Please follow us on Facebook and Instagram @bozemanpethospital
Payment Policy
All fees are due at time of service rendered. A deposit may be required for large invoices before services are performed. Payment of balance in full is require upon release of pet(s). We will gladly prepare a written estimate before services are performed at your request. If you are not provided with a written estimate please ask a team member. We accept cash, care credit, scratchpay and all major credit cards. We DO NOT ACCEPT CHECKS. In the event legal action should be necessary to enforce collection of fees, you hereby agree to be responsible for and pay all attorney fees, court costs and any other reasonable collection fee incurred. By signing below I agree that I have read and understand WellHaven Bozeman Pet Hospitals Payment Policy.
Signature
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