New Client Form

New Client Form
All new clients will be requested to leave a $57 deposit at the time of scheduling an appointment. This deposit will be applied to the first visit. However, in the event of a cancellation with less than 24 hour notice, it will be forfeiting the deposit. No-showing an appointment will also result in a loss of deposit. If a cancellation or reschedule is needed, we request a minimum of 24 hour notice to have the deposit applied to a new appointment date or possible refund. Thank you for your understanding. We look forward to exceeding your expectations! Your team at Family Veterinary Care of Oakdale
Owner Name*
Date of Birth*

MonthDayYear
Co-Owner Name
Date of Birth

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Home Number
Please enter a valid home number.
Work Number
Please enter a valid work number.
Cell Number*
Please enter a valid cell number.
Co-Owner Work Number*
Please enter a valid work number.
Co-Owner Cell Number*
Please enter a valid cell number.
Name of Previous Clinic*
Phone Number*
Please enter a valid phone number.
Military

YesNo
Senior

YesNo
Recommended by Whom?
Place of Employment

I/we hereby authorize the veterinarians to examine, prescribe for, or treat my pets (s). I/we assume full responsibility for all charges incurred in the care of this/these animal(s). I/we also understand that these charges will be paid in full at the time of release and that a deposit may be required for certain surgical treatments or other procedures.
Signature*

Clear
Should be Empty:

First Pet