New Client Forms

New Client Scheduling Information

  • Please contact the office to schedule before completing the form.
  • For second opinions, please contact the office to speak to the client liaison before scheduling.

PLEASE DO NOT COMPLETE THIS FORM UNTIL YOU HAVE A SCHEDULED APPOINTMENT. THIS FORM IS FOR CONFIRMED APPOINTMENTS ONLY. THANK YOU.

New Client Information Form

Thank you for allowing us to care for your pet. Please complete the online form below prior to your pet’s appointment.

Link to Printable PDF Version

If you prefer, you can download the PDF version of this form the link above.

Pitman Animal Hospital New Client Form

Primary Client/Owner Contact Info

Please complete the information below.


Primary Client/Owner Phone and Email

Please complete the information below.


Secondary Client/Owner Information

Please complete the information below.


Secondary Client/Owner Phone and Email

Please complete the information below.


Emergency Contact Information

Please complete the information below.


Allergy Screen

Why do we need this info? We often use peanut butter and cheese as a reward or distraction to make visits a pleasant experience for your pet.


Payment Information

Policies

  • All services and product sales must be paid for during service/sale.
  • A deposit of 50% of the total anticipated bill is required for all surgeries and/or hospitalizations.
  • Emergency cases require a deposit of 50% of the high estimate for the total bill before we can begin treatment*

If necessary, First aid will be initiated immediately without a deposit to save a patient's life.

Payment Methods

  • We accept cash, personal checks, Visa, Mastercard, Discover, & CareCredit. A photo ID is required for non-cash payment.
  • All returned checks are subject to a $25 service charge.
  • If paying by check, provide your Driver's License in the form below.

The First Pet In the Household

Tell us about your first pet.


The Second Pet In the Household

Tell us about your second pet.


The Third Pet In the Household

Tell us about your third pet.


The Fourth Pet In the Household

Tell us about your forth pet.


Photo Release

I give Pitman Animal Hospital permission to take photos of my pet and me for Pitman Animal Hospital's social media and marketing purposes. I release Pitman Animal Hospital from any & all claims regarding the use of these photos:


How Did You Hear About Us?

How did you hear about Pitman Animal Hospital?


Owner Release

By dating and typing in my name into the form below, I verify that all of the information provided is accurate to my knowledge. I am over the age of 18 and have read the foregoing document & fully understand its contents.


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