Please complete this form prior to your first appointment at Cedar Grove Veterinary Clinic.

New Client Form

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Email Address

Pet's Name

Reason for visit?

Birth Date (or best guess)

YYYY

Species

Sex

Breed

Declawed?

Authorization

I hereby authorize the Veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I understand that these charge MUST BE PAID AT THE TIME OF RELEASE and that a deposit may be required for surgical treatment. Please bring a copy of vaccination records with you to the appointment.

Date

YYYY

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New Client Form

218-877-7321

contact@cedargrovevetclinic.com