New Client Application

New Client Form

We love meeting new families who share our pet care goals and values. New patient appointment availability varies based on the time of year.

Name
Name
First
Last
Address
Address
City
State
Zip
Does this phone accept text messages?
Other Responsible Party (second pet parent in home, or if a single pet parent family your emergency contact person)
Other Responsible Party (second pet parent in home, or if a single pet parent family your emergency contact person)
First
Last
Does this phone accept text messages?
How did you first learn of our hospital?
Pet Species
Sex

Maximum file size: 52.43MB

Is your pet microchipped?
Our instagram handle is @healingpawsveterinary - does your pet have an Instagram handle?
What is the first appointment type you need to schedule for your friend? (Check all that apply)

Maximum file size: 52.43MB

Do you have any other cats or dogs in your household?
I am the legal owner or responsible party seeking veterinary care for the pet/pets identified and I certify that I am eighteen years of age or over.
At Healing Paws Veterinary Care, we recommend regular examinations, vaccinations, commercially prepared balanced pet foods, parasite prevention, regular dental hygiene procedures, and, when needed, collaboration with board-certified veterinary specialists to ensure your pet receives the very best care. Please select one of the following options.
Photo/Name Release: Healing Paws likes to use images of our client’s pets to demonstrate the care and attention that they receive here. When pets are happy and calm during treatment and care, it helps other pet owners to see how enjoyable veterinary care can be. Healing Paws will never share images of pets during the last moments of their lives, and we use discretion in the images taken and shared. We only use pet names and not owner names in our content. By signing below, I hereby give Healing Paws the right to use the name, video, and photographs of any of my pets in connection with its website and any promotional materials in any and all media, including, but not limited to, printed material, internet, social media, and film for display, public relations, and marketing. I hereby acknowledge receipt of adequate consideration and waive the right (i) to charge or be compensated for the use of the pictures, and my pet(s)’s name(s), and (ii) to inspect or approve the images prior to any form of usage. I understand that the images may be modified to use as design elements
Professional fees are due in full at the time of services rendered.

Payment Options: Cash, checks drawn from a local bank, debit cards, VISA, MasterCard, and Scratch Pay only

Deposits: Non-refundable deposits are required for illness appointments, first new client visits, in-patient appointments, and anesthetic procedures.

Estimates: At your request, we will gladly discuss the cost of services and/or prepare a written estimate for recommended procedures and treatments. Our goal is to provide your pet with thorough care that also fits your family's needs. We believe in recommending the best for your pet and your family - if you desire an estimate, please request one before authorizing procedures being performed.

Cancelled Appts: We ask that if you must cancel or reschedule your appointment, you do so greater than 24 hours of your appointment (72 hrs for anesthesia appointments). With the exception of emergency, management deemed extenuating circumstances all appointments that are canceled or rescheduled within 24 hrs of the appointment time (72 hrs for anesthesia appointments) or are no shows will be assessed a cancellation fee. The cancellation fee must be paid in full before rescheduling the next appointment in these situations.

Returned Checks: We charge a $100 fee for returned checks. This returned check charge and the client balance must be paid in full before scheduling any further appointments.

Failure to Pay: In the event you refuse or otherwise fail to make payment owed for services rendered by us in caring for your pet, you are responsible for any and all costs of collection incurred by us, including attorney's fees, to collect payment(s) from you.

I have read, understand and agree to the above statement
I represent that any information I provided above is accurate and agree to the terms set forth herein. I understand that payment in full is due to Healing Paws Veterinary Care, Inc. (“Healing Paws”) at the time services are rendered. I authorize Healing Paws to collect payment if I do not pay in accordance with this agreement and agree that I am responsible for all costs of collection, including, but not limited to, attorney’s fees and court costs. I have been informed that estimates for recommended services/procedures are available upon my request. I further understand that all services performed on my pet will be invoiced according to Healing Paws procedures.
Please check below.