New Client Form
Thank you for your interest in equine veterinary services provided by Dr. Erin Barrett of Spearhead Veterinary Services! Please provide the following information to help Dr. Barrett provide efficient, professional services for you and your horse(s). A copy of your responses will be emailed to you.If you have questions, please call or text Dr. Barrett at 641-352-6050, or email her at spearheadveterinary@gmail.com.
Client Information
Name
First Name
Last Name
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Preferred Method Of Contact
Email
Call
Text
How did you hear about us?
Facebook
Google search
At an event
Flyer
Existing client referral
Other
If you were referred by another existing client, please include their name below:
Horse Information
Please only add 1 horse in this form. An separate form will be available to add additional horses.
Name
Registered/ Show Name (N/A if none)
Barn Name
Current Horse Location (if different from billing)
Farm Name
Street Address
City
State / Province
Postal / Zip Code
Breed
Color
Age (approximate ok if unknown)
Gender
Mare/filly
Gelding
Stallion/colt
HISA Number (applies to racing Thoroughbreds only)
Microchip Number (if applicable)
Billing Responsibility/ Ownership Percentage
I am the sole owner and responsible for 100% of the billing on this horse
This horse is held in partnership and requires split billing (Dr. Barrett will reach out for that information)
Authorized Agent: if there is a person (spouse, trainer, barn manager, etc.) that can make veterinary decisions for this horse in the event that you cannot be reached, please add their contact information here.
Submit
Should be Empty: