New Client Form – Wildside

Date (mm/dd/yyyy) *

Client's full name: *

Address *

City *

State *

Zip Code *

Primary Phone Number *

Alternate caretaker

Please add anyone else that may be responsible for the pet.

Caretaker's Phone Number

Primary Email *

Payment Policies *

Thank you for choosing Wildside Veterinary Health Center. To serve you better, we ask that you review the following information on fees and payment. We make every effort to provide reasonable costs for services, but modern veterinary care can be costly. Unfortunately, we do not have the funds to provide free or low-cost care to our clients. Following an examination of your animal, the veterinarian in charge will provide an estimate of the approximate cost of services, procedures, tests, drugs, and supplies to treat your animal. This fee estimate will reflect only the initial diagnostic and treatment plan and may change, based on your treatment decisions. Payment is required at the time of service. A deposit is needed to schedule an appointment and before any medical or surgical procedure is performed. Any additional payment is due when your animal is discharged. Treatment of your animal is determined by your decisions, with consideration of your own financial resources. You have the right to decline any or all treatment suggested for your animal. We accept cash, Master Card, VISA, and Discover cards. I understand that I am responsible for all fees incurred in treating my pet and I am responsible for any collection fees incurred if my account balance is forwarded to collections. I agree that Wildside Veterinary Health Center may use photographs of me and/or my pet with or without my name, including purposes as publicity illustration, advertising, and/or web content. By checking this box, you accept these terms.