New Client Form

OWNER'S NAME
SPOUSE'S NAME
ADDRESS
IF NECESSARY, MAY WE CONTACT YOU AT WORK?
SPOUSE: IF NECESSARY, MAY WE CONTACT YOU AT WORK?
DO WE HAVE PERMISSION TO TEXT YOU WITH UPDATES/REMINDERS?
SPOUSE: DO WE HAVE PERMISSION TO TEXT YOU WITH UPDATES/REMINDERS?
HOW DID YOU HEAR ABOUT US?

Payment Authorization

By signing below, I hereby authorize the veterinarians and staff of Sullivan Veterinary Clinic (SVC) to examine, prescribe for, treat, and care for my pet(s).

I assume responsibility for all charges incurred in the care of my animal(s). I also understand that these charges are due and payable at the time of release and that a deposit may be required for surgical and/or emergency treatment. I understand SVC is not responsible for miscommunication between family members on issues including, but not limited to, billing, pricing, and/or authorization for examination, diagnostics, treatment, or product sales.

TO PREVENT THE SPREAD OF INFECTIOUS DISEASES AND PARASITES, HOSPITALIZED AND BOARDED ANIMALS MUST BE CURRENT ON ALL VACCINATIONS AND FREE OF INTERNAL AND EXTERNAL PARASITES.

By my signature below, I authorize the doctor(s) to provide vaccination and parasite control as needed for my pet at my expense.

We will be happy to provide an estimate of charges. Please request it prior to the treatment of your pet. Methods of Payment accepted:

  • Cash
  • *Check
  • CareCredit
  • Scratchpay
  • MasterCard
  • Visa
  • American Express
  • Discover