The Hoof Vet New Client Registration

Owner Full Name

First NameLast Name

Address Where Animal is Located

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Animal's Name

Barn NameShow Name

Species

Breed

Pet Age (years)

Pets Birthday if Known

Date

Sex

Colors or Markings

Primary Discipline or Use

Insurance Company (if applicable)

Please include pertinent medical history and reason for appointment:

Photo, Video and Case Information Consent (please click all that apply):

Preferred Contact Method

Consent to Treatment, Communication and Payment Agreement

Consent and Agreement: I authorize the veterinarian and staff to perform examinations, diagnostics, and treatments deemed necessary for the care of my horse(s) or dog/cat. I understand that while every effort will be made to provide the best possible care, veterinary medicine cannot guarantee outcomes.I consent to communication regarding my horse’s care via phone, text message, or email when appropriate. I also authorize the veterinary team to communicate with my horse’s farrier, trainer, or other members of my horse’s care team when it is beneficial for treatment and care coordination.I understand that this is a veterinary practice and agree that payment is due at the time services are rendered unless prior arrangements have been made. I accept responsibility for all charges related to the care and treatment of my horse(s).

Printed Name for Signiture

First NameLast Name

Signature

Today's Date

Date