New Client Form – Sisters Veterinary Clinic

New Client Information Form

Thank you for giving Sisters Veterinary Clinic an opportunity to care for your beloved pet. So that we may become better acquainted please complete the following:

Primary Contact*
First Last
Primary Contact #*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Contact Email:*
Second Contact
Secondary Owner
First Last
Relationship:
Secondary Contact#
Secondary Contact Email:
How did you choose our clinic?
- Internet
- Google
- Yellow Pages
- Newspaper
- Friend
Whom may we thank for referring you to us?
We accept cash, check, VISA, MasterCard, CareCredit
IT IS OUR POLICY TO PROVIDE YOU WITH AN ESTIMATE OF CHARGES FOR ANY CASES WHERE IN-HOSPITAL TREATMENT, SURGERY, OR HOSITALIZATION WILL BE PROVIDED. A DEPOSIT PRIOR TO TREATMENT WILL BE REQUIRED DEPENDING ON THE AMOUNT OF ESTIMATE. THE BALANCE AFTER DEPOSIT AND ALL OTHER SERVICES ARE DUE AND PAYABLE ON PET’S RELEASE.
Our credit and collections policy is a necessary albeit uncomfortable part of assuring the financial resources needed to maintain quality medical services to our patients. In order to establish optimal relations with our clients and avoid misunderstanding and confusion regarding our payment policies, our staff is trained to consistently inform you of the financial policies of this office. We request payment at the time of service.
Consent*
I verify to be the owner or agent of this pet and I grant permission to Sisters Veterinary Clinic to vaccinate, treat, perform any recommended/requested, or emergency medical care to my pet. I agree to pay for services rendered when my pet is discharged to me. Any past due amounts will be subject to interest at the rate of 2% per month.
If you arrive more than 10 minutes late for a scheduled appointment we will need to reschedule or be charged $75.00 to be worked in as an urgent care visit.
Signature*

New Client Information Form

Second Contact

We accept cash, check, VISA, MasterCard, CareCredit

Ready to Get Started?