503-236-1834

Become a Client

Thank you for giving us the opportunity to care for you pet. Please help us meet your needs better by taking a moment to share some important information we will need as we support your pet's needs today and in the future. (Please fill in as many of the blanks as you can.)

Client Information
Client's Name:
Street Address:
City, State Zip: ,  
Home Phone:
Mobile Phone:
E-mail:
Drivers License No:
State of Issue:
Employer:
Work Phone:

Spouse / Partner Information
Name:
Employer:
Work Phone:
Mobile Phone:
Email Address:
Children / Visitors:

Other Infomation
How / Why did you
select us:
If Referral or Other,
please explain:
Previous Veterinary
or Clinic:

Pet Information
Type of Pet:
Other (explain):
Name:
Sex: Male  Female
Spayed / Neutered: Yes  No
Describe your Pet:
Allergies or Other
Info we should
know:

Important Information and Approval

We will gladly prepare a written estimate if you desire (please ask your doctor or the receptionist). All professional fees are due at the time services are rendered. In case of extensive medical or surgical procedures, and other times when full payment may be difficult to make at the time of discharge, we accept MasterCard, Visa, Discover, or we can establish a payment arrangement (with prior approval). There will be a $25.00 service charge for any check returned unpaid.

To prevent the spread of infectious diseases, all hospitalized and boarded patients must be current on all vaccines and free from internal and external parasites. The person below authorizes this level of preventative care and the appropriate charges will be assessed in the discharge invoice.

Person Responsible
For Pet: