New Client Form

Save time during your new client appointment. Complete your required form online from any device at any time before your visit.

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New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.

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Name *

Spouse

Phone Number *

Phone Number

Reminders are sent by text and e-mail, please provide a good e-mail and cell phone number to send these to.

Phone Number to Receive Text Reminders *

Email to Receive Reminders *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

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Home Number

Work Number

Our clinic is active on social media, Facebook, Instagram and TikTok. Please state if you give permission to post pictures or videos of you or your animal on our clinic pages. *

Yes
No

Payment Policies are as follows:

Payment is due at the time of service
We accept cash, credit card (Visa, Mastercard, Discover and American Express) CareCredit, Scratchpay or personal checks with appropriate ID and phone number
In some cases, a deposit is required before services are performed

I agree to the payment policies of Blount Veterinary Clinic. I also understand that I am solely responsible for all fees associated to the care and treatment of any animal brought in to the clinic.

Signature *

Date *

Name

New Client Form

New Client Form

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Ready to Visit?

Address

Contact Information

Hours

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