New Client & Pet Registration Form

Client Info *
Client Info
Client Date of Birth (DOB), necessary to prescribe DEA controlled medications to your pet
Client Date of Birth (DOB), necessary to prescribe DEA controlled medications to your pet
Spouse/Partner
Spouse/Partner
Phone (primary) *
Phone (primary)
Phone (secondary)
Phone (secondary)
Address
Address
Birthday
Birthday
Which Eye(s) Involved? *
duration of the problem? please specify in days/weeks/months or years
Symptoms *
check all that apply
Who May We Thank For The Referral?
Veterinarian
Veterinarian
Friend or Family
Friend or Family
TERMS OF SERVICE *
As your appointment time is reserved specifically for you, Vision Care for Animals has a cancellation/no-show policy. Out of consideration for our patients , staff and our Doctor, we ask that you notify us 24 business hours in advance should you need to cancel or reschedule your appointment. Our business hours are Monday through Friday, 8am to 5pm. Messages left on Fridays or on weekends for Monday appointments do not qualify as advance notice because we do not retrieve those messages until Monday morning. Vision Care for Animals will charge a $65 cancellation fee for missed appointments and late cancellations without 24 business hour advance notification. We do understand that unanticipated events happen occasionally; emergency cancellations are handled on an individual basis. As a courtesy, Vision Care for Animals has text, email, and voice reminder capability to help remind you about your appointment date and time; however, it does remain the client’s ultimate responsibility to keep track of schedule appointments.