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New Client Form

Client / Owner Information
Address
About Your First Pet
Has your pet had any illness in the last year?
Is your pet on heartworm prevention?
Is your pet on flea/tick prevention?
May we contact your current or previous veterinarian for medical records?
Has your pet had any illness in the last year?
Is your pet on heartworm prevention?
Is your pet on flea/tick prevention?
May we contact your current or previous veterinarian for medical records?
Marketing

I hereby authorize the veterinarian 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 also understand that these charges must be paid in full, at the time of release of the pet.

Client Notices

By signing below I understand payment is due in full at the time the services are rendered. A deposit may be required for any medical procedure before patients are admitted. At check-in, we request a $100 new client deposit for all first-time clients. This is only done on the first visit and it goes towards your pet's visit. If we owe you money after we will refund the remaining back to you at checkout. There is a service charge on all returned checks. If I have limited funds I will communicate that with Ridgetowne Animal Clinic at the beginning of the visit so they can prepare an estimate of the cost prior to treatment.

By signing below I give Ridgetowne Animal Clinic permission to request my pet’s medical records from any other veterinarian or clinic.

By signing below I understand all pets must be current on rabies vaccination (Unless the patient is deemed not healthy enough to receive vaccines) and be free of internal and external parasites before being admitted to the clinic (including fleas, ticks, hookworms, roundworms, etc.). If these cannot be verified the pet will be vaccinated, bathed, treated, and/or dewormed at an additional charge to the client. 

By signing below, I agree and understand that the information provided above is true and not misrepresented. I also agree that I am over 18 years of age. 
I have read and understand this authorization and consent. I, the above signed owner, certify that I am eighteen years of age or older. 
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