248-624-4829 Book Now

New Client Form

Owner's Name(Required)
Address(Required)
Which number is best to reach you?(Required)
Can you receive text messages?
Add a Co-Owner?(Required)

PET HEALTH HISTORY

Sex
Neutered/Spayed?
Please bring and give any medical records/vaccine records to the receptionists to make copies.

OFFICE POLICIES

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal.(Required)
I understand that if I no-show for an appointment, a $50 deposit will be required to schedule future appointments.(Required)
I understand that payment is ALWAYS DUE IN FULL at time of service. A deposit of 50% of the treatment plan may be required before treatments or hospitalization of your pet. I recognize that financial concerns should be discussed PRIOR to examination and treatment.(Required)
Do we have your permission to share your pet’s image and story on our social media, website, and other forms of related media?(Required)
I authorize my emergency contact (other than myself) to pursue treatment if I am unavailable. Your emergency contact must be an adult over the age of 18.(Required)
Emergency Contact(Required)
Clear Signature
MM slash DD slash YYYY
Max. file size: 128 MB.

Ready To

Make an Appointment?

248-624-4829 Book Now