SAAC Client/Patient Info Form

  • Thank you for choosing South Athens Animal Clinic for your pet's needs. Please fill out our client/patient registration form to ensure we can provide you with the best possible care.
  • Have you ever brought a pet to South Athens Animal Clinic before?*
  • Format: (000) 000-0000.
  • Is this your home, cell, work phone or other number?
  • Format: (000) 000-0000.
  • Is this your home, cell, work phone or other number?
  • How Would You Prefer To Be Contacted?*
  • Is there a spouse/partner/family member who should be listed on your account?*
  • Format: (000) 000-0000.
  • Is this a home, cell, work phone or other number?
  • How did you hear about us?
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  • Species*
  • Sex*
  • Is your pet microchipped?*
  • Would you like us to call your previous veterinarian to obtain medical records?
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  • 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) and share their name on Facebook, Instagram, and/or other social media outlets we may choose to use?*
  • South Athens Animal Clinic occasionally uses email and text for communications regarding our patients' reminders for health care needs. Do we have your permission to contact you via email and/or text regarding these reminders? Your phone number will not be shared with third parties for marketing or promotional purposes.* I agree to receive text messages from South Athens Animal Clinic regarding account notifications and reminders for health care needs at the phone number I provided. I understand that my consent to be contacted is not a requirement to purchase any product or service. Message & data rates may apply. Message frequency varies. I can opt out at any time by replying STOP or HELP for assistance. I agree to the Terms of Service and Privacy Policy.*

  • FINANCIAL POLICY:

    Our office accepts Visa, Mastercard, Discover, and American Express. We also accept cash and checks.

    In addition, we also offer a 3rd party financing option 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 upon request. Your signature below indicates your agreement with these policies.

  • TREATMENT CONSENT:

    By signing this document, I declare I am the lawful owner of the above listed pet and all information is true and correct to the best of my knowledge. I hereby authorize the veterinarian(s) of South Athens Animal Clinic to examine, prescribe for and treat my pet 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 exception of another veterinary facility.

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