New Patient Enrollment Form

New Patient Information

Thank you for selecting Cascade Animal Clinic for your pet's needs. Please fill out our new patient registration form in entirety to ensure we can provide you and your pet with the best possible care.
IMPORTANT:

We require 24 hours or more notice to cancel or reschedule your appointment.
Owner's Name*

First NameLast Name
Do you need to make any adjustments to your account? (Change of address, add and/or remove a person or patient, new phone number, etc.)*

NoYes
Information to be changed:*
Due to a recent increase in bite occurrences to our staff and doctors, we are requiring ALL pets seen at Cascade Animal Clinic to be current on their Rabies vaccine, unless the doctor determines that it is not appropriate due to medical reasons.

If proof of an up to date Rabies vaccine cannot be provided before your appointment date/time, one will need to be given when the patient is here.
Pet's Name*
Upload A Picture of Your Pet

Browse Files

Cancelof
Species*

DogCat
Date of Birth/Age of Your Pet*
Breed (If your cat is not a known breed, do they have long, medium or short hair?)*
Color*
Sex*

MaleNeutered MaleFemaleSpayed Female
Is Your Pet Microchipped?*

YesNoI'm not sure
Microchip Number (if known)
Primary Reason for Visit to Cascade Animalc Clinic?*
Do You Already Have a Scheduled Appointment?*

YesNoI scheduled an appointment through your website/Facebook
Appointment Date

MonthDayYear
Date
Appointment Time

:HourMinutesAM/PM Option
Previous Veterinarian(s)*
If None, Please Let Us Know That.
Previous Veterinarian(s)*
If none, please let us know that!
Previous Veterinarian Phone:

Area CodePhone Number
May We Contact Them for Your Pet(s) Records?*

YesNoOther
Upload Previous Veterinary Records

Browse Files
Please upload if available. Cancelof
Client Policies and Procedures

We want you to be aware of and understand the following policies and procedures for all clients.
We Love Social Media! Do we have your permission to post pictures of your pet(s), you and your pet(s) and/or your pet(s) and our team on Facebook, Instagram, Twitter, www.cascadeanimalclinic.com, and any other marketing and/or other social media outlets we may choose to use?*

YesNo
I agree to release Cascade Animal Clinic from all claims for libel, slander, invasion of privacy, infringement and copyright or right of publicity or any other claim and confirm that you are over the age of 18 years old. (initial below)*
Initial
FINANCIAL POLICY:

Our office accepts Visa, Mastercard, Discover, American Express, Apple Pay, and Android Pay.

In addition, we also offer several 3rd party financing options for our clients via Care Credit. Care Credit requires that payment only be made for services as they are rendered, we cannot charge services to your account in advance. Additionally, use of Care Credit requires that the card be present every time and that two forms of identification are verified. We appreciate your understanding of our desire to protect your account/identity.

As financing options are offered, we cannot offer additional in-house payment plans for our services. Clients needing additional financial support are encouraged to apply for Care Credit with a co-signer.

Full payment is due at the time of service. This includes any charges/fees agreed to by my authorized proxy. Our team is happy to provide any client with a written treatment plan prior to services being rendered. Your signature below indicates your agreement with these policies.
TREATMENT CONSENT:

By signing this document, I declare I am the lawful owner of all listed pets and all information is true and correct to the best of my knowledge. I hereby authorize the veterinarian(s) of Cascade Animal Clinic to examine, prescribe for, or treat the my pet(s) to the best of their abilities. I assume responsibility for all charges incurred in the care of this animal. I acknowledge that medical information will not be released to anyone not indicated on this form without my express verbal and/or written permission with the except of another veterinary facility.
*
Should be Empty:

New Patient Information

IMPORTANT:

Client Policies and Procedures