New Client Form

Save time during your appointment. Complete your required forms online from any device at any time before your visit.

New Client Form

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

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OWNER INFORMATION

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Cell *

Primary Email *

Layout

Alternate Contact *

Phone *

Relationship *

PATIENT INFORMATION

Pet's Name *

Species *

In order to best manage your pet’s medical care, it is important to have a full medical history; please allow us to contact your previous vet.

Layout

Veterinary Practice *

Phone Number *

We would love to thank the persons responsible for your referral *

Cole Veterinary Clinic (CVC) maintains an Internet (social media, website, etc.) presence for purposes including marketing and client education. Part of this presence includes photographs of our practice and its daily workings. Therefore, we may be interested in using images of your pet(s) and/or family as part of the effort to maintain, expand, and educate the public about our business and services, as well as include clients in every aspect of our practice. Please let us know how we may use/post photographs of your pet(s) and/or family: *

CVC has my permission to use or post photographs of my pet(s) and/or self/family
CVC may NOT use or post photographs of my pet(s) and/or family

Full payment is due when services are rendered. WE DO NOT ALLOW BILLING OF ANY KIND. On your request, we can provide a written estimate of expected diagnostics and treatment recommendations. Surgeries, hospitalizations, and emergency services may require a deposit prior to treatment. Our staff will be happy to discuss finance options, such as Care Credit with you. *

I have read this statement and I agree

Signature *

Date *

Cole Veterinary Clinic uses PetDesk® to manage client communications, send you reminders about upcoming appointments, patient reminders of services due, and status updates regarding your pet while they are here in our hospital. You agree that we may share your name, pet’s name, email address, address, and phone number with PetDesk to facilitate this process. To learn more about PetDesk or their privacy policies, please visit www.PetDesk.com or download their iOS or Android mobile applications.

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New Client Form

New Client Form

OWNER INFORMATION

PATIENT INFORMATION

Location

Contact Information

Hours

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