New Client Form

Save time during your next appointment. Complete your new client information form online from any device at any time before your visit.

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number *

Alternate Phone Number

Email *

Pet's Name *

Type of Pet *

Sex *

Breed *

Color *

Age/Date of Birth *

Additional Pets: Include Name, Sex, Breed, Color, and Age

AUTHORIZATION *

I hereby authorize Lone Tree Animal Care Center to examine, prescribe for, and/or treat my pets. I assume full responsibility for all charges incurred for the care of all my pets on my file. I also understand that payment is due at the time services are rendered and that a deposit may be required for surgical treatment or hospitalization. I also assume responsibility for any collection charges for a balance due for any reason.

Signature *

Clear Signature

Signature Date *

Name

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