New Client Information Form

PHONE

EMAIL

FIRST NAME

LAST NAME

ADDRESS

CITY

STATE

ZIP CODE

NAME OF PET

Species Species DOG CAT

BREED

COLOR

AGE or DATE OF BIRTH

Sex Sex MALE (unaltered) MALE (neutered) FEMALE (unaltered) FEMALE (spayed)

Does your pet have a microchip? Does your pet have a microchip? YES NO

Is your pet current on their vaccines? Is your pet current on their vaccines? YES NO

Any previous medical concerns / history?

Can we share photos of your pet on social media? Can we share photos of your pet on social media? YES NO

PAYMENT IS EXPECTED AT THE TIME OF SERVICE - We accept Cash, Visa, MC, Discover, and Care Credit PAYMENT IS EXPECTED AT THE TIME OF SERVICE - We accept Cash, Visa, MC, Discover, and Care Credit YES I understand the payment policy

We require 24-hour notice for ALL cancellations or reschedules. If you cancel or reschedule without a 24-hour notice or no-show for your appointment, a deposit will be required in order to reschedule, and a no-show fee may be applied. We require 24-hour notice for ALL cancellations or reschedules. If you cancel or reschedule without a 24-hour notice or no-show for your appointment, a deposit will be required in order to reschedule, and a no-show fee may be applied. YES I understand the cancellation policy

I hereby authorize the veterinarians at Osseo Veterinary Clinic to examine, prescribe for or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I understand that these charges must be paid at the time of release and that a deposit may be required for surgical procedures and treatment. I hereby authorize the veterinarians at Osseo Veterinary Clinic to examine, prescribe for or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I understand that these charges must be paid at the time of release and that a deposit may be required for surgical procedures and treatment. YES I authorize the treatment of my pet

In Lieu of a written signature - Please type your full name

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