Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Preferred form of Communication *

Email
Text
Call

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Reason for Visit *

Schedule a Wellness Appointment
Concerns about my Pet

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

First

Last

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 *

Age/Date of Birth *

Pet Color

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

**If your pet is sick or needs care quickly, please Call Us so that we can help your pet in a timely manner**

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your Pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your Pet. We accept Cash, Visa, MasterCard, Discover, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

New Client Form

PLEASE GIVE US AT LEAST 24-48 HOURS NOTICE FOR NEW CLIENT FORM

Petplex Animal Hospital, the Right Vet for your Pet.

Contact Info

Location

Hours

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