NEW CLIENT FORM

Tell us about you and your pet!

Your Contact Information

Name *

Spouse's name *

Email *

Address *

Home Phone *

Cell Phone *

How did you find out about our clinic? *

If personal recommendation, please provide us their name:

Your Pet's Information

Pet #1

Species *

Breed *

Sex *

Color *

Neuter/Spay? *

Date of Birth *

Pet #2

Species

Color

Breed

Sex

Neuter/Spay?

Date of Birth *

I will pay for services by: *

I am the owner of the above animal, or am responsible for it, and will be fully liable for payment for all fees incurred. Payment is due in full at the time of the services - WE DO NOT BILL. (By typing your name you agree to these terms; this is the same as signing your name)

E-Signature

Please read carefully. Colonial Veterinary Hospital, Inc. has business and medical staffing hours as follows:

The hospital is closed Saturdays, Sundays, and holidays. Therefore, this is to inform you that we have no in-house, on-duty continuous medical staff care overnight from closing time at 6:00 PM Friday to opening time 7:30 AM Monday. If an animal is required to stay in the hospital over the weekend, Dr. Riley will be in to administer medications and adhere to the animals needs several times a day. (By checking the box below you agree to these terms; this is the same as signing your name)