New Client Information Form

Thank you for giving us the opportunity to care for your pet. Please help us meet your needs by taking a moment to complete this New Client Information Form. We look forward to working with you in maintaining your pet’s health. Please fill out the online form.

    Your Name (required):

    Your Email (required):

    Street Address:            

    City, State, Zip Code:    

    Home Phone: Cell Phone: Work Phone:

    How did you hear about Elk Meadow Animal Hospital:

    Communication Preferences: E-mailMail

    Other Contact Information:

    Name: Relationship: Phone: E-mail:

    * For your pet’s protection, we require all vaccinations or titers be current before hospitalization and surgery. If vaccines are not current, your pet must receive them before staying in our facility.

    * Owners who abandon their pets will be prosecuted.

    * Payment in full is expected at time of service. Accounts not paid as agreed will be subject to collection costs, including attorney fees. Monthly interest fees at the rate of 1.5%, monthly service charges, and returned check fees will be added to outstanding accounts.

    * Immune status of your household: People who are immuno-compromised are at increased risk of disease transmission from their pet. Any persons: under 10 or over 60 years old; or who have had a splenectomy; are HIV+, on steroids, or pregnant would be at risk.
    Is anyone who has regular contact with your pet immuno-compromised? NoYes

    I agree that I have read and understand the above policies and that I am over 18 years of age.

    Client's Printed Signature: Date:

    If you would prefer to print and complete this form before visiting Elk Meadow Animal Hospital, please click:
    Elk Meadow Animal Hospital Client Information Form