New Client Form in Iowa City, IA | All Pets Veterinary Clinic

Owner Name*
Co-Owner Name
Address*
Street Address Address Line 2 City State ZIP Code
Email Address
Home Number
Work Number
Cell Number*
Co-Owner Work Number
Co-Owner Cell Number
Name of Previous Clinic
Previous Clinic Phone Number
Recommended by Whom?

Any medical conditions we should be aware of?
Does your pet have any allergies to medications? If so, please list them.
What food does your pet(s) eat?*
Is your pet on any medications? Please include name, dose, and instructions. (This includes heartworm & flea/tick preventative, and supplements)
Please use the space below to give us any relevant information for your pet.
Do we have your consent to post your pet(s) pictures on our social media platforms?*
- Yes
- No
I hereby authorize the veterinarian to examine, prescribe for, or treat the above pet(s).*
- Yes
- No
Upload Pet Records
Drop files here or
General Policies
We require established care between the veterinarian, client, and pet before treating or prescribing medications. Your pet must be examined yearly for continuous establishment. We reserve the right to discontinue care at any point.
Financial Policies
We accept all forms of card payment (Visa, Amex, Discover, Mastercard), cash, and checks.
Payment is due at time of service. Unpaid balances will incur a monthly fee and statement.
It is the client's responsibility to request an estimate.
Clinic Safety
Dogs must be leashed at all times.
Cats must be in a carrier. One per carrier.
The client is responsible for the pet's behavior. Please keep them away from other pets and let staff know if they require certain accommodations due to behavioral concerns.
Signature*
Date*
I understand by electronically signing this document that I acknowledge and accept the terms above.
If you need to schedule an appointment - Click Here
Comments
This field is for validation purposes and should be left unchanged.

All Pets Veterinary Clinic

New Client Form

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Pet

Additional Pets

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