New Client Information Form

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Primary Pet Owner Name

First

Last

Secondary Pet Owner Name

First

Last

Home Address

Street Address

City

State

Zip Code

Phone Number

Phone Of Primary

Preferred Method Of Contact Regarding Your Pet?

Phone Call
Text
Email

Clients Consent

I understand that all invoices and bills must be paid in full when services are rendered. For your convenience we accept Visa, Mastercard, Discover, American Express, Care Credit and Cash. Checks are not accepted as a form of payment at Classen View Veterinary Clinic. All credit cards must be physically present at time of payment. We cannot key in or manually enter any credit card information.
I allow any photos taken by team members at Classen View Veterinary Clinic to be used on Classen View’s social media platforms. No personal information other than the pets name will be used.
I do not allow any photos taken by team members at Classen View Veterinary Clinic to be used on Classen View’s social media platforms. No personal information other than the pets name will be used

Signature

By selecting the “Submit” button, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By selecting “Submit” using any device, means, or action, I consent to the legally binding terms and conditions of this document. I further agree that my signature on this document is as valid as if I signed the document in writing. I am also confirming that I am authorized to enter into this Agreement. If I am signing this document on behalf of a minor, I represent and warrant that I am the minor’s parent or legal guardian. I may decline to electronically sign this document and withdraw my consent to sign this document electronically by contacting the signature requestor directly, which may delay transactions. I may contact the signature requestor separately to request to sign this document on paper or to receive a paper copy of the signed document. Any fees for such paper copy will be charged then by the signature requestor. When I sign the document, I will receive a copy of this document via email.