New Client Form

Save time during your next new client appointment. Complete your required form online from any device at any time before your visit.

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New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.

Just print, fill out and bring along with you.

Download New Client Form PDF

Thank you or giving us the opportunity to care for you pet. We’ll be happy to answer any questions you may have about your pets health. To insure the best care possible, please take the time to fill out this form completely.

Date *

Owner's Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone *

Cell Phone

I consent to receive SMS text messages from County Line Animal Hospital. Msg & data rates may apply. Reply STOP to opt-out. *

Yes
No

Emergency Contact Number

Patient Health History

Name of Pet *

Species

Canine
Feline

Breed

Color

Date of Birth *

Sex *

Male Intact
Male Neutered
Female Intact
Female Spayed

Please provided copies of current vaccine history / current medications prescribed to front desk or list the name and number of hospital patient is currently associated with.

Click or drag a file to this area to upload.

Authorization *

I hereby authorize County Line Animal Hospital to examine, prescribe for, or treat the above described pet. I assume responsibility for all changes incurred in the care of this animal. I also understand that these charges will be paid in full at the time of pets release.

Signature of Pets Owner *

Date

Message

New Client Form

New Client Form

Just print, fill out and bring along with you.

Patient Health History

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