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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

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

Pet Owner/Client Information:

Address**
MM slash DD slash YYYY

Pet Information: (For more than one pet, ask for an 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

SMS Consent
Email Consent