Fayetteville Animal Clinic Client Form

Fayetteville Animal Clinic Client Form
Thank you for giving Fayetteville Animal Clinic the opportunity to care for your pet. Please complete the following:
Owner
Spouse
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Email*
example@example.com
Employer
City and State
Work Phone Number

Area CodePhone Number
Spouse's Place Employment
City and State
Spouses Work Phone Number

Area CodePhone Number
So that we are able to suit your individual needs – which do you feel most applies to you:
Check One

I prefer to be present when my pet is examined/treated.I would rather not see my pet examined/treated.
Check One

I feel that my pet is another member of our family.I feel that my pet is just a pet.
Check One

I want the best medical care available for my petI want good medical care for my pet, but there is a limit to what I am able to have done.I want you to perform only the services that I request.
PAYMENT IS REQUIRED, IN FULL, UPON COMPLETION OF VISIT. Deposits are required on major medical/surgical cases, trauma cases, and after hours emergency work where hospitalization is required.
Please Choose Payment Method

CheckCash
Credit Card

MCDISCOVERCARE CREDITVISAAMEX
Should be Empty: