vetfield.com - New Client Registration

New Client Registration
When you tell a friend (new client) about us, and they bring their pet for an appointment you get a $25 credit toward In-House Services & they get a FREE EXAM with us. That’s a WIN-WIN!

Thank you for choosing us as your pet(s) veterinary facility. Please take a moment to fill out this form so we may better assist you.
Date:

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Email:
example@example.com
Full Name:

First NameLast Name
Spouse:
Address:

Street Address

Street Address Line 2

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Postal / Zip Code
Best Number:
Please enter a valid phone number.
Alternate number:
Please enter a valid phone number.
Please tell us how you found us

Walk inFacebookGoogleTwitter/InstagramBreederVetfield websiteFamilyOther ClinicBoss Pet ConnectionsName of Pet StoreGrouponCurrent ClientFriendOther

Pet (s) Information

Please sign the following consent for treatment: I consent I am 18 years of age or older. I understand that I will be financially responsible for all procedures and services rendered at the time of visit. I also understand that a written estimate is available upon request. A payment may be required for all drop off services (boarding/surgery/urgent care). I hereby authorize Vetfield Animal Hospital to render any treatment that is deemed necessary to my pet (s) health while in custody of the hospital. In the event of an emergency the staff will make every attempt to contact me if time permits to get authorization to proceed with treatment(s). We accept Cash, Visa, MasterCard (we do not accept checks). I understand that Vetfield Animal Hospital does not take any payment plans and payments may be required upfront for any types of services.
Signature:

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Date

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