HOSPITAL HOURS:

M-F 8am-5:30pm

(Closed Wed. 12pm-2pm)

Sat 8am-4pm

Copyright © 2008 Prescott Valley Pet Clinic

All Rights Reserved

New Clients

For your convenience, you can fill out the new client form and submit it online. 

Thank you for giving us the opportunity to care for your pet!

Your Name:

Spouse/Other:

Mailing Address:

City:State:Zip Code:

Primary Phone:Secondary Phone:

E-mail Address:

Previous animal hospital where previous records can be obtained?

Phone number of previous animal hospital:

Pet's Name:

Date of Birth:Breed:

Color:Sex/Altered

Pet's Name:

Date of Birth:Breed:

Color:Sex/Altered

Pet's Name:

Date of Birth:Breed:

Color:Sex/Altered

How/Why did you select us?

Name(s) of children who might accompany you and your pet:

Type your full name here:

Cat

Dog

Other

FemaleSpayed Female MaleNeutered Male

Cat

Dog

Other

FemaleSpayed Female MaleNeutered Male

Cat

Dog

Other

FemaleSpayed Female MaleNeutered Male

DirectoryInternet LocationReferralPrevious ClientCoupon

I agree the information I am submitting is correct. I have read and agree to the terms below. You must be 18 years of age to agree to the terms on this form. We will gladly prepare a written estimate if you desire. Please ask your doctor or client service representative. I assume responsibility for all charges incurred in the care of the animals named above. ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. There will be a $50.00 service charge for any check returned unpaid. Prescott Valley Pet Clinic will be staffed during routine business hours only. Hospitalized patients will receive treatments and medications after hours as prescribed by the attending veterinarian. Phone calls after hours will be forwarded to the answering service and the doctor on call will be paged with any medical emergencies. By submitting this form online you are agreeing to these terms. Your information received will only be used by Prescott Valley Pet Clinic. We take your privacy seriously and never give this information to third parties.