New Patient Form

New Patient Form

New Patient Form

Thank you for choosing Pleasant Valley Pet Clinic. In order to maintain communication about your pet's care, please take a moment to give us the following information:

New Client Form

Do you prefer to be referred by your:

Does your pet have pet insurance?
Is your pet the best pet in the world?
Would your pet like his/her photo posted on our Facebook page?
How were you referred to our animal hospital?
May we request a copy of your pet's medical records from another veterinarian?
We offer payment plans through Care Credit. Would you like to apply?

I acknowledge that I am seeking veterinary care for my pet, and I certify that I accept financial responsibility for all charges incurred. I understand that payment in full is due at the time of service, and that service charges will accrue on any unpaid balance. A deposit is required for all hospitalized animals.

Payment Method:

For the safety of all animals here, it is our policy that all hospitalized patients be free of parasites and current on vaccinations.