Patient Intake Form

This form is for registering your pet with our clinic. Please note, this form is not for scheduling appointments or services.

CLIENT / PATIENT INFORMATION

Thank you for giving us the opportunity to care for your precious pets.Please help us to meet your needs by completing this form.

PAYMENT OF FEES ARE DUE AT THE TIME OF SERVICES RENDERED

Our forms of accepted payment are: Cash, Check, Visa, MasterCard, Discover, American Express and Care Credit. To prevent the spread of infectious diseases and parasites, all pets that are here for daycare, hospitalized, and/or boarded, must be current on Rabies, Distemper, and Bordetella for dogs and current on Rabies, Distemper for cats. We also require our patients to be current on flea and heartworm preventions.

I, the owner of the above pet(s), authorize the staff to provide vaccines and control programs as needed for my pet to maintain proper health, as according to the policies at the Westerville Veterinary Clinic, LLC. I also, hereby agree to pay the total amount accrued at the time of my pet’s discharge.