New Client Form

Please fill out the New Client Form prior to your first appointment. We look forward to meeting you.

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at (706) 387-0006 for a faster response.

Name *

First

Middle

Last

Date *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email Address *

Primary Phone *

Secondary Phone

Spouse/Co-owner

Spouse Phone

Name of Referral

Emergency Contact Name *

First

Last

Relationship *

Phone *

Pet's Name *

Species *

Dog
Cat
Other

Sex of Pet *

Male
Neutered Male
Female
Spayed Female

Breed *

Color *

Birth Date *

Does your pet have a microchip identification? *

Add a second pet? *

Has your pet seen a previous Veterinarian? *

All fees are due at the time services are rendered. An estimate for services will be provided upon request. A deposit of 50% is required for surgical procedures, emergencies, and hospitalization. The balance will be due upon discharge. We accept cash, all major credit cards, checks, and Care Credit. There will be a $45 service charge for returned checks. No out of state checks or cashier's checks will be accepted. There is a charge for missed doctor appointments in the amount of $40 and a charge for missed surgery appointments in the amount of $80. If you need to cancel or reschedule your appointment please let us know asap. *

I have read and accept

Signature of responsible party *

Date *

Website

New Client Form

New Client Form

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Location

Contact Information

Hours