Palmetto Vet Hospital | New Client Form

Name*

First Last

Email*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Place of Employment

Work Phone

Pet Info

Pets Name*

Type of Pet*

Breed

Color

Sex*

Spayed/Neutered*

Name of Former Vet

Are your pet's vaccines current?

Yes
No

Do you have medical records?

Yes
No

May we request a transfer of records?

Yes
No

Would you like us to call you for an appointment?

Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here:

Please Read

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 the animal. I understand that ALL PROFESSIONAL FEES ARE DUE NOW, unless prior arrangements are made. I also understand a late fee of 1.5% will be added to any account that becomes (30) thirty days PAST DUE and late fees will continue to be charged until your account is PAID IN FULL. Also please be advised that all appointments missed may be subject to a fee of $12. I have read this statement and -

I Agree
I Disagree

New Client Form

Pet Info

Our Location

Contact Info

Proudly Accredited By