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New Client Form

Client Information Form
Name
Name
First Name
Last Name
Spouse / Other Name
Spouse / Other Name
First Name
Last Name
Address
Address
City
State/Province
Zip/Postal
Please select one of the options below
How did you learn about Cat Care Clinic?
In the event that Cat Care Clinic is contacted by another veterinary medical facility for my cat’s records or vaccination history, I authorize the release of those records.

I, the undersigned owner or authorized agent of the cat identified herein, hereby consent to the examination and treatment of the indicated cat(s) and I assume responsibility for all charges. I understand that I have the right and duty to discuss any charges prior to treatment. I also understand that if payment is not made as agreed, my account will be turned over to a debt collection agency and all legal and collection expenses will be added to my total bill.

Full Payment is due upon release of patient.

A deposit may be required for admitted patients. We accept all major credit cards as well as Care Credit. Sorry, but we cannot accept checks on your first visit.