New Client Form - Harmony Pet Clinic

Pet Owner's Name *

First

Last

Email *

Email will be used to send you reminders about appointments and services due unless you opt out,

Phone Number *

Cell phone preferred so that you can get texts from us.

Address *

Please provide the physical address of the pet.

Name of your Pet *

Age or DOB of your Pet *

Write approximate or unknown if not sure.

Species of your Pet *

Dog/Canine
Cat/Feline
Other

Breed of your Pet

Pet's Gender *

Male
Neutered Male
Female
Spayed Female

Color of your Pet

How did you hear about us: *

Additional Pets:

Add Name, age, breed and sex if you have more than one pets

Reason for the pet's visit

Please briefly describe the purpose of your first appointment with the veterinarian at Harmony Pet Clinic

Previous Veterinarian/Clinic/Hospital

By providing this information you give us permission to get your pet’s medical records.

Agreement: I hereby authorize the veterinarian to examine, prescribe for, and/or treat my pets. I assume full responsibility for all charges incurred for the care of all my pets on my file. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment or hospitalization. *

I agree