New Client Registration Form

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New Client Registration Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

You may use the PDF version by clicking the DOWNLOAD FORM button and then completing the printed form by hand. Please bring the completed PDF form with you for your pet’s first appointment.

DOWNLOAD FORM

Owner's Name *

First

Last

(Mr, Miss, Ms, Dr.)

Spouse/Other

First

Last

Email Address *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone *

Cell Phone *

Spouse Cell Phone

Place of Employment *

Work Phone *

May we contact you at work *

If referred by someone, please tell us whom we can thank

I AGREE

Signing this document shows that acknowledge and agree upon the following terms and conditions:

I am over the age of eighteen and hereby authorize the veterinarians to examine, prescribe, and treat my pet as is agreed upon by the veterinarian and myself. I assume full responsibility for the charges incurred during my visits. I acknowledge that Paws Veterinary Clinic and Grooming Spa does not bill for its services and all fees are due at the time services are rendered. We will gladly prepare an estimate for services upon request. In the case of extensive medical services, a deposit may be required.

We accept: cash, Visa, MasterCard, American Express, Discover, and CareCredit. Checks are accepted, however returned checks for any reason will be assessed a $25 return check fee. In the event of default, I understand that the balance due may be placed with a collection agency and I agree to pay all reasonable attorney fees, court costs, and/or collection agency fees.

Signature *

Clear Signature

Date *

Phone

New Client Registration Form

New Client Registration Form

I AGREE

Think Paws.. Because We Care!

Contact Info

Address

Hours

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We Proudly Serve the Pets of Joplin, MO and the Surrounding Areas

Joplin

Webb City

Carl Junction

Carthage

Neosho