New Client Form

Please complete the form below before your visit.

Welcome!

If you’re planning your first visit to Prelesnik Animal Hospital, we look forward to meeting you. To save time on your first visit, we encourage you to print and fill out our new patient forms below.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's health care? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Coat Color *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Previous Veterinary Clinic (if applicable)

All new clients are required to put a deposit down in the amount of the $70 (the cost of the exam) before scheduling an appointment. *

I have read and agree to the payment.

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your pet. We accept cash, Visa, MasterCard, Discover, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

Name

New Client Form

Welcome!

The best health care for your furry loves ones.

Contact Us

Address

Hours

Have a questions?