Client Information

Owner's Name *

First

Last

Email *

Main Contact Number *

Secondary Contact Number

Address *

Address Line 1

Address Line 2

City

State

Zip Code

How Would You Prefer To Be Contacted? *

Is There a Spouse/Partner/Family Member Who Should Be Listed On Your Account?

Yes
No

Spouse/Partner/Family Member Name: *

First

Last

Please tell us how the above person is related to you so we can refer to your relationship appropriately. *

Spouse/Partner/Family Member Contact Number: *

In case of emergency...

Is there anyone else (besides above listed contacts) who should be listed on your account, who has ongoing permission to make medical decisions for your pet(s)?

Yes
No

Emergency Contact: *

First

Last

Relationship: *

Phone Number: *

How did you hear about us? *

Please tell us who we may thank for your referral!

Pet's Name *

Species *

Dog
Cat

Date of Birth/Age of Your Pet *

Breed & Color (If your cat is not a known breed, do they have long, medium or short hair?) *

Sex *

Male
Neutered Male
Female
Spayed Female

Is Your Pet Microchipped? *

Yes
No
I'm not sure

Microchip Number (if known)

Primary Reason for Visit to 4Paws Veterinary Group? *

Do You Already Have a Scheduled Appointment? *

Yes
No
I scheduled an appointment through your website

Appointment Date *

Appointment Time *

Previous Veterinarian(s) *

Do you have a second pet?

Yes
No

Pet's Name *

Species *

Dog
Cat

Date of Birth/Age of Your Pet *

Breed & Color (If your cat is not a known breed, do they have long, medium or short hair?) *

Sex *

Male
Neutered Male
Female
Spayed Female

Is Your Pet Microchipped? *

Yes
No
I'm not sure

Microchip Number (if known)

Do you have a third pet?

Yes
No

Pet's Name *

Species *

Dog
Cat

Date of Birth/Age of Your Pet *

Breed & Color (If your cat is not a known breed, do they have long, medium or short hair?) *

Sex *

Male
Neutered Male
Female
Spayed Female

Is Your Pet Microchipped? *

Yes
No
I'm not sure

Microchip Number (if known)

Do you have a fourth pet?

Yes
No

Pet's Name *

Species *

Dog
Cat

Date of Birth/Age of Your Pet *

Breed & Color (If your cat is not a known breed, do they have long, medium or short hair?) *

Sex *

Male
Neutered Male
Female
Spayed Female

Is Your Pet Microchipped? *

Yes
No
I'm not sure

Microchip Number (if known)

If you have more than 4 pets, please let our office know and we will happily collect information to add them to your account.

Client Policies and Procedures

We want you to be aware of and understand the following policies and procedures for all clients.

We Love Social Media! Do we have your permission to post pictures of your pet(s), you and your pet(s), and/or your pet(s) and our team on Facebook, Instagram, Twitter, www.4pawsvetgroup.com and any other marketing and/or other social media outlets we may choose to use? *

Yes
No

I agree to release 4Paws Veterinary Group from all claims for libel, slander, invasion of privacy, infringement and copyright or right of publicity, or any other claim and confirm that you are over the age of 18 years old. (initial below) *

Initial

4Paws Veterinary Group uses email, text, and our own hospital app for communications regarding our patient's reminders for health care needs. Do we have your permission to contact you via email, text, and/or our app regarding these reminders? *

Yes
No

4Paws Veterinary Group no longer provides reminders for appointments or services due by mail. If you choose not to be contacted by email, text, and/or our hospital app, we cannot guarantee timely reminders regarding your pet(s) health. If choosing not to provide permission to contact you digitally, please initial below indicating that you understand the above and release 4Paws Veterinary Group from any liability surrounding notification (timely or otherwise) regarding your pet(s) health care needs. *

Initial

FINANCIAL AGREEMENT

I/We agree to pay for services rendered at the time services are provided, without exceptions. I/We understand that failure to pay for services at the time provided, and/or failure to rectify unpaid invoices due to returned payments, may result in collections involvement and/or termination of the veterinarian/client relationship.

We do not accept checks.

Payment types available are cash, debit card, credit card, care credit, or scratch pay.

NO SHOW, LATE CANCELLATION, & DEPOSIT POLICY

No Show Policy: I understand and accept that a $79 fee (per pet scheduled) will be applied to my account and will be immediately due payable in the event of a “No Show” to any scheduled appointments.

A “No Show” will be defined as:

Failure to show up for scheduled appointments completely.

OR

Arriving 15+ minutes later than the scheduled appointment time.

OR

Rescheduling exam appointment less than 1 hour before scheduled appointment time.

Surgery Deposit & Cancellation/Reschedule Policy:

I understand and accept that a $100 deposit (per pet scheduled) will be required to schedule any surgical/anesthetic procedure.

I also understand and accept the following terms:

This deposit is non-refundable.

If I/We reschedule or cancel the surgical procedure with less than 24 business hours notice to the hospital, the entire deposit amount is forfeited.

If a surgical deposit was not taken to schedule for any reason and I/We reschedule or cancel the surgical procedure with less than 24 business hours notice to the hospital, then a $100 fee will be charged to my account and will be immediately due payable.

Appointment Deposit & Cancellation/Reschedule Policy:

I/We understand and accept that a $79 deposit (per pet scheduled) will be required for all new clients who have not been seen at our hospital before, and for any existing clients with a history of scheduling issues as determined at the sole discretion of 4 Paws Veterinary Group.

I/We also understand and accept the following terms:

This deposit is non-refundable and will be applied as a credit to the client account.

If I/We reschedule or cancel the appointment with less than 24 business hours notice to the hospital, the entire deposit amount is forfeited.

If I/We reschedule or cancel the appointment more than 24 business hours in advance of the scheduled appointment time, the deposit will remain as a credit on the client account.

Financial Agreement *

I agree to the Financial Agreement terms.

BEHAVIOR EXPECTATIONS

At 4 Paws Veterinary Group, our mission is to provide exceptional patient care and compassionate client communication. Providing you with a high level of care and service requires mutual respect, cooperation, and kindness. To nurture an inclusive and mentally healthy environment for both clients and staff, we have instituted a code of conduct for all 4 Paws Veterinary Group clients.

We respectfully ask the following of our clients:

Understanding, Empathy, and patience. We are empathetic to our patients and clients and appreciate the same in return. Please understand that our team works with individuals and pets with varying levels of need, and in certain situations may need to prioritize their time accordingly. Our individualized approach to patient care relies heavily on equitable time management for all.

We have a zero-tolerance policy for the following behaviors:

Verbal abuse, malicious or harmful statements, profanity, or degrading comments directed at any member of our staff or fellow clients.

Any form of harassment including but not limited to cyberbullying, discriminatory comments and/or actions, and intimidation tactics and/or threats.

Refusal to pay for products and/or services.

Non-compliance may result in being asked to leave the property, and/or terminating the veterinarian/client relationship.

Behavior Expectations *

I acknowledge and agree to the Behavior Expectations policy.

TREATMENT CONSENT:

By signing this document, I declare I am the lawful owner of all listed pets and all information is true and correct to the best of my knowledge. I hereby authorize the veterinarian(s) of 4Paws Veterinary Group to examine, prescribe for, or treat my pet(s) to the best of their abilities. I assume responsibility for all charges incurred in the care of this animal. I acknowledge that medical information will not be released to anyone not indicated on this form without my express verbal and/or written permission with the except of another veterinary facility. *

Clear Signature

New Client Form

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Client Information

In case of emergency...

Client Policies and Procedures

FINANCIAL AGREEMENT

BEHAVIOR EXPECTATIONS

TREATMENT CONSENT:

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Whether your pet needs a routine check-up, specialized treatment, or an urgent care visit, we are here to help!

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