All Creatures Veterinary Center

New Client Form
Owner Name*

First NameLast Name
DL#*
Owner Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Home PhoneWork PhoneCell Phone
Opt InOpt Out
Spouse Name

First NameLast Name
Spouse Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Spouse Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Spouse Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Home PhoneWork PhoneCell Phone
FriendSignallcreaturesonline.comWeb SearchCouponOther
If friend, please tell us their name so we can send their referral gift*
Number of dogs
Number of cats
Number of other pets (specify)
YesNo
YesNo
Reason for Visit:*
Pet Information
Name of Pet*
DogCatOther
Breed*
Color*
MaleFemale
YesNo
Date of Birth
Vaccination History (Date, type, and place of last vaccination):
Please note any symptoms or problems you have noticed about your pet:
Pet's current medications:
Describe your pet's diet:*
If you have medical records for your pet(s), please upload them here. These records help us provide the best care for your pet(s) by ensuring we have accurate information about their health history, vaccinations, and any ongoing treatments.

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Payment and Authorization Policy
We are happy to provide an estimate of charges. Please request it prior to treatment of your pet.

By signing this agreement, I authorize the veterinarians and staff of All Creatures Veterinary Center to examine, prescribe for, treat and care for the above-described pet. To the best of my ability, I have provided full disclosure of this pet's medical history prior to being seen. I assume responsibility for all charges incurred in the care of this animal and understand that the charges are due and payable at the time of service and/or release and that a deposit may be required for surgical and/or emergency treatment. Additionally, I understand that should a balance exist on my account for any reason, monthly interest of 1.5% will be charged. I also understand that after 90 days, unpaid balances will be submitted for collection and I agree to pay for the costs of collection, including all legal fees and costs of court.

Types of Payment:
- Cash
- Mastercard
- Visa
- American Express
- Discover
- CareCredit
Credit Card Policies:

All Creatures Veterinary Center will accept these credit cards under the following conditions: The card must be presented by the card owner and the card owner must show a valid Texas Driver’s license on request as proof of ownership. Any other conditions or arrangements for use of a credit card require additional documentation and the approval of the manager. All Creatures does not accept checks as payment.
I have read, understand and agree to the above Payment and Authorization terms as well as to the Check and Credit Card Policies of All Creatures Veterinary Center. I agree that an electronic copy of this signed agreement is the legal equivalent of the original paper document.
Signature of Owner*

First NameLast Name
Today's Date*

MonthDayYear
Date
Should be Empty:

New Client Form

Pet Information

Payment and Authorization Policy