New Client Sheet

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Welcome To
Walton Way Veterinary Clinic
Dr. Jennifer Vann, D.V.M. – Dr. Heather Tucker, D.V.M.
Client/Patient Information
Date:
/ / .
Owners Name:
Spouse/Other:
Address:
City:
State:
Zip:
Home Phone # (
)
Cell Phone # (
)
Work Phone # (
)
Spouse’s Phone # (
)
Work Place:
How did you hear about us?______________________________________________________
Email Address:
Payment is due at time of services and we will gladly prepare a written estimate if you desire.
Please ask the receptionist. We accept visa, master card, discover, care credit, or cash. If this
is a problem please discuss with the receptionist before being seen by the doctor, also there is
a 45.00 fee for all appointments not cancelled within 24 hours.
Please list current pets:
Name
Birth Date
Breed
Sex
Spayed/Neutered
Yes/no?
Color
To prevent the spread of infectious diseases and before treatments can be initiated, all pets
must have a current rabies vaccination. If your pet is not current you will be required to get
one during your visit. I authorize the doctor to provide vaccines and parasite control that is
needed for my pet as deemed necessary by a D.V.M.
Signature:
_____ Date:
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