New Client Form – Clayton | Clayton Veterinary

Thank you for giving our animal hospital the opportunity to care for your pet. Please be informed that Clayton and Churchtown Veterinary Associates are two separate hospitals but share staff and medical philosophy. We look forward to meeting you and your animal companion!

Submitting this form at least 24 hours before your appointment will allow us to have your chart ready when you arrive.

Please note that this form is not for scheduling Holistic Consultations, and you will not receive a Holistic Consultation upon completion of this form. If you wish to schedule a Holistic Consultation, use the following form: Holistic Consultation Form

Owner's Information

Owner's Name

Spouse's Name

Your Email

Primary Phone

Secondary Phone

Address

Apt, suite, etc.

Country

City

State

Zip code

Employer

Emergency Contact Information

Name

Phone

How Did You Hear About Us?

Select One

Person Who Referred Me

Pet Information

Pet Name

Species

Breed

Date of Birth (mm/dd/yr)

Color

Microchip ID

Sex

Spayed or Neutered?

Previous Vet Name

Please Note:

This form is only for clients who have an appointment already scheduled and wish to complete their new client paperwork ahead of time. If you do not have an appointment yet, please call us at 856-881-7470.

Payment is expected at the time services are provided. If necessary please ask for an estimate of cost before agreeing to services. For your convenience we accept the following forms of payment: Cash, Debit, Visa, Mastercard, Discover, American Express, and Care Credit.

Please type your initials below to indicate that you have read the above notes: *

Please bring a fecal sample to your appointment!

This sample should be collected no more than 24 hours before the appointment and can be brought in a plastic bag or a disposable container.

New Client Form - Clayton

Learn how you can become a client

Clayton Veterinary

Churchtown Veterinary