New Client Registration Form

New Client Registration Form

Please only fill out this form if you are a client coming to our office for the first time!
Customer Details:
Primary Contact Name*

First NameLast Name
Spouse or Significant Other's Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Significant Other's Phone Number
Email for Primary Contact
example@example.com
Significant Other's Email
example@example.com
How did you hear about us?*
Please Specify*
Previous Veterinary Office Information*
We need to recieve your pet's records before your appointment so our staff can properly prepare for your first visit. If you do not have a previous veterinary office, please state that in the text box above. Failure to provide medical records before the appointment date may result in appointment delay, reduced amount of time available with the doctor, or rescheduling of your appointment to a later date.
Pet(s) Information*
Please list your pet's names, date of birth (or approximate age), breed, color, gender, and if they are spayed/neutered.
Use of my Pet's Photo's on Social Media

Approve of Pictures of my Pet(s) to be Used on Social MediaDecline Social Media Exposure
Financial Policy

We accept all major debit/credit cards, Money Orders, Apple Pay, Google Pay, and cash. We are no longer accepting personal checks.

Our office accepts CareCredit. This is a credit card that offers 18 months of interest free financing for visits over $200. Subject to credit check.

We provide EVERY appointment with an email confirmation that includes an estimate of services. If you are unable to afford the services estimated, please let us know ahead of time so we are able to work within your budget.

Please sign below to acknoweldge that you are financially responsible for your entire pet's veterinary bill at the time that services are rendered. Failure to submit complete payment may result in legal action.
Signature*

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Missed Appointments & No Show Policy

Effective immediately, a deposit is required for all scheduled appointments.

Appointments without a deposit within 3 days of scheduling will be cancelled. If you need to cancel or reschedule, we kindly ask for at least 48 hours' notice.

Due to our consistently full schedule, this policy helps ensure we can provide timely care to as many pets as possible.

While we understand this may be an inconvenience, this step has become necessary due to repeated last-minute cancellations and no-shows. Your deposit will be applied as a credit toward your final invoice.

If you reschedule or cancel with at least 48 hours' notice, the deposit will be fully refunded to your original payment method or transfer to the new appointment. After 3 reschedules, you will be required to pay a new appointment deposit.

What is Considered a No Show?
- Not showing up to your scheduled appointment
- Arriving 15 minutes late to your scheduled appointment
- Cancelling within the 48-hour cancellation window
Please remember, we are a small, single veterinarian, clinic with limited space and staff. While we always do our best to accommodate emergencies, priority is given to existing clients.

We sincerely appreciate your understanding, continued support, and trust in our care.

Please sign below to acknowledge & agree to our cancellation policy.
Signature*

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