New clients

New Client Form

Fill this out before your first visit and we'll have everything ready when you arrive. It takes about 5 minutes.

Required

Owner Information

First name

Last name

Street address

Address line 2

City

State

ZIP

Phone

Birth date

You must be 18 or older to authorize treatment.

Driver's license

Optional.

How did you hear about us?

Who referred you / other

Optional.

Co-Owner Information (optional)

First name

Last name

Phone

Pet Information

Pet's name

Species

Sex

Birth date

An estimate is fine.

Breed

Color

Is your pet microchipped?

Is your pet insured?

What would make your pet more comfortable during their vet visit?

Authorization

By checking this box, you are agreeing to the following terms: PAYMENT IS DUE AT TIME OF SERVICE. We accept Cash, Personal Check from established clients with verification of a current Driver’s License, VISA, MasterCard, Discover, American Express, ATM/Debit, and ScratchPay. You understand and agree that in the event of default, to pay reasonable collection and/or attorney fees. You authorize FAH to photograph my pet for medical records and social media purposes. You agree to allow PetDesk (internal reminder system) to use this information in providing your services, including contacting you via Text and e-mail.

I Accept

New Client Form

Thanks!