New Client Form

Your Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Primary Cell*
Secondary Cell
Your Email*
Place of Employment*
Work Phone
Driver’s License#
Spouse’s Name
First Last
Spouse’s Phone
Our clinic offers automatic reminders, would you like yours:*
- Text
- Email
- Both
Patient Information
Patient Name*
Date of Birth*
MM slash DD slash YYYY
Breed*
Sex*
- Male
- Female
- Spayed
- Neutered
Color*
Allergies
Special Diets
Add a second pet?*
- Yes
- No
Second Patient Information
Patient Name*
Date of Birth*
MM slash DD slash YYYY
Breed*
Sex*
- Male
- Female
- Spayed
- Neutered
Color*
Allergies
Special Diets
Add a third pet?*
- Yes
- No
Third Patient Information
Patient Name*
Date of Birth*
MM slash DD slash YYYY
Breed*
Sex*
- Male
- Female
- Spayed
- Neutered
Color*
Allergies
Special Diets
Terms of Service
I authorize Boyer Veterinary Clinic to treat any of my pets. I am aware that all treatment and medication charges are in addition to the exam fee and agree to pay all charges incurred by the time of release of my pet. We accept all major credit cards, Care Credit, cash and checks with proper identification.*
- I authorize
All information I have provided here is true to the best of my knowledge.*
- I have read and understand the Terms of Service.
Signature*
Date*
MM slash DD slash YYYY
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