Name
*
First Name
Last Name
Email
*
example@example.com
Primary phone
*
Please enter a valid phone number.
Secondary phone
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Who else is authorized to make decisions about your pet's healthcare?
First Name
Last Name
Phone Number
Please enter a valid phone number.
How did you find out about our hospital? If you were referred by someone, who should we thank?
*
Pet's name
*
Species (canine/dog or feline/cat)
*
Breed
*
Age/date of birth
*
Sex
*
Male
Neutered male
Female
Spayed female
Did you have a prior veterinary clinic? If so, please list the name and contact information if you have it so we can contact them for past medical history and vaccinations.
Does your pet have microchip identification?
*
Yes
No
There may be times when we would like to record audio of your pet's appointment. While not required, these recordings help to ensure that we have a full and complete medical record. Do you consent to Trusted Friend Animal Clinic creating audio recordings of your pet's appointment?
*
Yes
No
Social Media Consent: Do we have permission to share any photos or videos of your pet taken in our practice, to our social media platforms?
*
Yes, I give consent
No, I do not give consent
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 and estimate form and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way we have to know for sure 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.
Submit
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