All Creatures Animal Hospital and Luxury Boarding Suites / New Client Appointment

New Client Appointment

To Better Assist you, please complete the following information:

Form - New Client Appointment

Name (required)
First Name (required)	Last Name (required)

How Did You Hear About Us?

Text Area

Address (required)
Street Address (required)


City (required)	State/Province (required)	Zip/Postal Code (required)
,

Daytime Phone (required)
Phone Type	Phone Number (required)

Evening Phone (required)
Phone Type	Phone Number (required)

E-Mail Address (required) :

Pet's Name (required)

Age: Years, Months (required)

Type of Pet: (required) :

Breed and Color: (required)

Sex: (required) :

Appointment Day: (required) :

Time (Please Verify our Days & Times on our Hours Page): (required) :

Would you like us to call you to confirm your appointment:

Are your pets vaccines current?

Do you have pets medical records?

Medical records at another veterinary Practice? (required) :

Name of Former Veterinary Practice (required)

May we request a transfer of records? (required) :

Reasons or conditions that prompted your visit? (required)

Special requests or conditions?

Our Pets Are: (required) :

Please list any additional pets here:

Pet Medical History Info:
Illnesses or Surgeries
Allergies to Vaccinations or Medication
Special Diets or Medications

Please Explain Pet Medical History Info Above:

Selection (required) :

Please Read:
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at All Creatures Animal Hospital and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to All Creatures Animal Hospital's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges. I hereby give All Creatures Animal Hospital and Luxury Boarding Suites permission to take and use photos of my pet(s) for educational purposes and/or post on their website or social media sites if needed.

I Agree to All Creatures Hospital and Luxury Boarding Suites Policies and Procedures

The verification code below ensures the form is not submitted by a computer

Verification Code :

Enter the code you see in the graphic below in this box.
Your post will not be allowed if you do not type this in correctly.