New Client Form

Rustic Line

Welcome new clients!

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

Thank you for your cooperation in letting us assist you.

Download New Patient Form

"*" indicates required fields

Pet Owner/Client Information:

Address**
MM slash DD slash YYYY

Pet Information: (For more than one pet, ask for additional pet form)

MM slash DD slash YYYY
Please check any symptoms your pet is currently showing

300 words max

I Approve My Pet’s Picture and Their First Name to be Used in Social Media
** Please bring in a stool specimen so we can check for parasites **
Authorization:

I authorize the veterinarian to examine, treat, or prescribe for my pet(s). I assume responsibility for all charges incurred in the care of the animal(s). I also understand that all professional fees are due at the time services are rendered.
Returned check fee: $20

This field is for validation purposes and should be left unchanged.