New Client

We look forward to seeing you and your pets. To make check in smoother, please fill out the new client form prior to coming in!

* Indicates required field

Legal Owner *

First

Last

SPOUSE/OTHER OWNER *

MAILING ADDRESS *

Line 1

Line 2

City

State

Zip Code

Country

EMPLOYER *

MAY WE CALL YOU AT WORK? *

YES NO

MOBILE NUMBER *

HOME NUMBER *

SPOUSE PHONE *

WORK PHONE *

Email *

EMERGENCY CONTACT/AUTHORIZED AGENT WHO IS ABLE TO MAKE MEDICAL/FINANCIAL DECISIONS *

First

Last

Phone Number *

Do you consent to electronic communication? This could include text and/or email. *

YES NO

MAY WE USE PHOTOS OF YOUR PET ON SOCIAL MEDIA? *

YES NO

PAYMENT OF FEES IS REQUIRED IN FULL AT THE TIME SERVICE IS RENDERED.
Upon your request we will provide a written estimate of fees. A deposit prior to treatment may be required. There is a finance charge applied to all accounts unpaid after 30 days at a rate of 1.5% per month with a minimum charge of $1.50. There is a $35.00 returned check fee.

Please indicate your choice of payment: *

CASH VISA/MC CHECK

By submitting this form, I am electronically signing/submitting and that I agree to the below:
I am at least 18 years old and the owner or authorized agent for the above animals.
I understand that I am responsible for payment.

Submit

New Clients, Welcome!

408 West 3rd Street
The Dalles, OR 97058

Phone: 541-296-9191
Email: thedallesvet@gmail.com

Follow us on Facebook: The Dalles Veterinary Hospital

New Clients, Welcome!

408 West 3rd Street​The Dalles, OR 97058​Phone: 541-296-9191Email: thedallesvet@gmail.comFollow us on Facebook: The Dalles Veterinary Hospital​

408 West 3rd Street
The Dalles, OR 97058

Phone: 541-296-9191
Email: thedallesvet@gmail.com

Follow us on Facebook: The Dalles Veterinary Hospital