Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Who was your previous vet, if any? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Does your pet have any diagnosed conditions? *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a second pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Does your pet have any diagnosed conditions? *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a third pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Does your pet have any diagnosed conditions? *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fourth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have any diagnosed conditions? *

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fifth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have any diagnosed conditions? *

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Payment is due in full at the time services are provided. If your pet is being admitted to the hospital, we are unable to begin care until you have confirmed your consent by: 1. signing the client consent and estimate form, and 2. providing an initial deposit of 50% of the upper end of the estimate. This ensures we have your clear approval to proceed with your pet’s care. We accept payment by cash, Visa, MasterCard, Discover, and CareCredit. We do not offer credit or billing for services. Any unpaid invoices will be sent to collections after 45 days unless prior arrangements have been made. *

I have read and accept the financial policy.

Submitting this form does not guarantee acceptance as a client. Our team will review your submission and respond within 2 business days.

If your pet is experiencing an emergency, please call the clinic directly for immediate assistance.

New Client Form

New to Edward Veterinary Services? Fill Out Our New Client Form!

Thank you for choosing Edwards Veterinary Services for your pet’s care.

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