New Client/Patient Form

Owner Information

Owner's Name(Required)
Spouse/Co-Owner Name
Address(Required)
If necessary, may we call you at work?

Pet Information

How did you learn about Animal Medical Clinic?

Fees for all services, medications, and products are due as they are performed. We require a deposit when your pet is admitted for major medical, trauma, or surgical care and when hospitalized. Please check the method of payment you will be using today:
*We use electronic verification for checks. All checks are processed electronically immediately as we receive them. For your convenience, and to save you a paper check, you might prefer to use your check/debit card. A driver’s license, phone number and date of birth are required on ALL paper checks. A minimum returned check fee of $30 will apply for all returned checks other processing fees may occur.

To help us respond to your individual needs, please check one in each of the three sections below which most applies to you:
Do you give us permission to use photos of your pets on our website and social media platforms?
Consent(Required)