New Patient Form

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Is this person *

Emergency Contact
Co-owner

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have an additional pet we will be seeing for the first time? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

What day and time have you scheduled your appointment with us? *

Hospital name, address and phone number where your pet was seen previously *

**PLEASE BRING ALL PREVIOUS RECORDS WITH YOU TO YOUR APPOINTMENT WITH US**

Financial Policy & Media Consent

By signing below, you agree to the following terms:

Payment Responsibility: Payment is due in full at the time services are performed unless otherwise arranged. For hospital admissions, we require:
- A signed Client Consent & Estimate Form, and
- An initial deposit of 50% of the upper end of the estimate before care begins. This ensures we can proceed with your pet’s treatment without delay.
Payment Methods: We accept cash, Visa, American Express, MasterCard, Discover, and CareCredit. We do not extend credit or bill for services. Any open invoices not paid within 45 days will be sent to collections unless prior arrangements are made.
Photo & Media Consent: During your visit, our staff may take photos or videos of your pet for documentation, educational, or promotional purposes. With your consent, these images may be shared on our social media platforms, website, or other marketing materials. You may revoke this consent at any time by notifying our office in writing.

I have read and accept the financial policy.

Please contact us to make your first appointment before completing the new patient form below.

New Patient Form

Please contact us to make your first appointment before completing the new patient form below.

Financial Policy & Media Consent

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