Please note: We will close for Christmas at 12 pm on Tuesday, December 24th – Thursday, December 26th.

Existing Client Form

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Existing Client Form

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

Name *

First

Last

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address is the same as your Physical Address? *

Email *

Home Number *

Work Number

Cell

Spouse Cell

Drivers License *

D.O.B *

Person(s) authorized to use this account

Relationship

Add another authorized person to this account? *

I understand and agree that all services rendered me, my dependents, or others assigned by me to my account are charged directly to me. I further understand I am personally responsible for payment. If I suspend or terminate care and treatment, any fees for services rendered will be immediately due and payable. Should the fees for the professional services not be paid in accordance with the provisions herein, reasonable attorney’s fees, plus applicable finance charges and disbursements, allowances and costs provided by law shall be included in the computation of the amount due. Finance charges can be applied to all amounts that are atleast 60 days past due at the rate of .83% per month (9.96% annual rate). If the account is in default and turned over for collection, I acknowledge that I will be responsible for all reasonable costs associated with effecting collection. If during the admission or application process I have provided a cell phone number; I acknowledge that I may be contacted at that number for account servicing matters, including but not limited to collecting on my account should it become delinquent. *

I have read and accept the financial policy.

Signature of Owner / Agent *

Clear Signature

Date *

WARNING: UNDER TEXAS LAW (CHAPTER 87, CIVIL PRACTICE AND REMEDIES CODE), A FARM ANIMAL PROFESSIONAL IS NOT LIABLE FOR AN INJURY TO OR THE DEATH OF A PARTICIPANT IN FARM ANIMAL ACTIVITIES RESULTING FROM THE INHERENT RISKS OF FARM ANIMAL ACTIVITIES.

Name

Existing Client Form

Existing Client Form

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*Closed from 12 pm-1 pm for lunch every day.