REFER A FRIEND & EARN $20 IN VET CREDIT

for your four-legged mates! Just make sure they list your name in the form below.

NEW CLIENT FORM

We treat your pet like family.

Welcome new clients!

We know you have a lot of choices when choosing the best Logan Village veterinary hospital, and we’re happy that you’ve decided to join the Village Veterinary Care Clinic family. Please complete the form below before your visit.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your Pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your Pet. We accept Cash, Visa, MasterCard, Discover, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

Upload Patient History From a Previous Vet

Click or drag files to this area to upload. You can upload up to 5 files.

Upload a Photo of Your Pet

Click or drag a file to this area to upload.

Name