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New Client Form

Fill out this form if you’re new and would like to join the New Richmond Veterinary Clinic family!

New Richmond New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Please upload any relevant files

Click or drag files to this area to upload. You can upload up to 10 files.

Payment is due in full at the time that services are performed. If being admitted into the clinic, we cannot begin the care of your Pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain 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.

I agree to allow my pet to be photographed while in the clinic and posted on social media for the clinic’s use. This could include but is not limited to Facebook, the clinic website, etc. There will be no personal identifying information associated with the post other than names. I hold harmless New Richmond Veterinary Clinic for any events arising from or misuse of the photo from social media on non-clinic platforms. I understand there will be no right to compensation for such use of my pet’s photo. *

I accept
I decline

I authorize New Richmond Veterinary Clinic to obtain records and other information from other clinics my pet has been treated or examined previous or after my visit at New Richmond Veterinary Clinic. If declining this consent I understand that it could compromise my pet’s care. *

I accept
I decline

I authorize New Richmond Veterinary Clinic to release records of my pets’ care and information to another animal facility as requested. This may include shelters, groomers, clinics, and referral centers. Without this approval we cannot release the information without approval for each individual occurrence. *

I accept
I decline

We will always obtain specific approval for release to other individual persons (such as new pet owners).

Name

New Client Form

New Richmond New Client Form

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