New Client Information

Primary Veterinarian
Does your pet currently have a primary veterinarian?

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Primary Veterinarian Office Name
Location
Phone Number
Please enter a valid phone number.
Do we have your permission to contact that veterinarian office to transfer your pet's records to our office?

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Agreement
I, the undersigned owner or authorized agent of the above admitted patient(s), agree to assume responsibility for all charges incurred, and agree to pay all such charges at the time of service/release.

ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED.

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for treatment. A finance charge of 1 ½% will be charged monthly on any balance due. Enid Pet Hospital and its representatives may contact me via phone, automated emails, or text messages regarding my pet’s health and my account. MUST BE 18 YEARS OR OLDER.
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Today's Date*

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Client Information