New Client Form

Call Us Today! (248) 934-2835

Welcome to our veterinary clinic and thank you for giving us the opportunity to care for your pet. We look forward to working with you in maintaining your pet’s health. So that we may become better acquainted with you and your pet, please complete the following:

OWNER INFORMATION:

Your Name

Spouse’s Name

Address

Apt#

City

State

Zip

Home Phone

Cell Phone

Your Email

How did you find us?

Personal Recommendation*: (Name)

* Please let us know if someone referred you to our clinic so that we may send them a thank you!
 
Where we can get your pet's records?

Hospital Name

Address

Phone Number

 
PET(S) INFORMATION:
PET#1

Your Pet's Name

Species

Gender

Neutered/Spayed?

Breed

Color

Date of Birth

Or approximate age

Pet Insurance Information:

PET#2

Your Pet's Name

Species

Gender

Neutered/Spayed?

Breed

Color

Date of Birth

Or approximate age

Pet Insurance Information:

PET#3

Your Pet's Name

Species

Gender

Neutered/Spayed?

Breed

Color

Date of Birth

Or approximate age

Pet Insurance Information:

**By completing this new client form, I, the undersigned owner or agent of the owner, certify that I am 18 years of age or older, and do hereby authorize Orion Animal Care Center veterinarians and technicians to examine my pet(s) named above and administer treatment as is considered necessary for my pet’s condition.

**AUTHORIZATION/PAYMENT POLICY: Payment is due when services are completed or when patient is released. If you have any questions regarding fees, we will be happy to discuss them with you at any time. We accept Visa, Master Card, Discover, American Express, Care Credit and personal checks and cash payments. Please note there is a $20 charge if your check is returned by the bank. I assume responsibility for all charges incurred in the care of my pet.

Please prove you are human by selecting the Star.

/* */