New Client Form

Thank you for choosing vetdash as your preferred veterinarian!

New Client Form

We are glad to have the opportunity to care for your pet. To ensure your pet gets the best care we can offer, please fill out the following form completely.

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

Reason for Visit *

Treatment Authorization

Please check off each statement below

I HEREBY AUTHORIZE THE VETERINARIAN TO EXAMINE, PRESCRIBE FOR, AND/OR TREAT MY PETS I ASSUME FULL RESPONSIBILITY FOR ALL CHARGES INCURRED FOR THE CARE OF ALL MY PETS ON MY FILE. I ALSO UNDERSTAND THAT THESE CHARGES WILL BE PAID AT THE TIME OF SERVICES. *

I authorize and agree to charges

I understand that I will need to give VetDash Veterinary Care LLC staff a minimum of 24 hours notice when needing to cancel or reschedule an appointment. *

I understand

I accept that there are potential risks with any vaccination, medication, or treatment provided. I accept that there is also potential risk with declining medical recommendations. I understand and release VetDash Veterinary Care LLC of any liability associated. I understand it is my responsibility to contact VetDash Veterinary Care LLC or seek care at an Emergency Hospital if any adverse reaction has occurred. *

I accept the risks

Signature of Owner/Agent *

Clear Signature

Date *

Phone

New Client Form

New Client Form

Treatment Authorization

vetdash is here to help!

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