New Client Registration Form

* Indicates required field

Primary Name *

First

Last

Secondary Name *

First

Last

Primary Phone Number *

Select Type *

Secondary Phone Number *

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Address *

Line 1

Line 2

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State

Zip Code

Country

Primary's Employer *

Phone Number *

Secondary's Employer *

Phone Number *

Additional Contact Name *

First

Last

Phone Number *

Policies

As the primary owner on this account, I authorize that I am 18 years or older *

Yes

I assume responsibility for all charges incurred in the care of my pet(s). I also understand these charges will be paid at the time of service/release of my pet(s) and a deposit may be required for surgical services and/or treatment. We accept all major credit cards, debit cards, CareCredit, and Cash as forms of payment. *

I understand

I authorize McMonigle Veterinary Hospital to release records to boarding, grooming and other veterinary clinics if requested. *

I understand

Scheduling appointments to accommodate our client's needs is a priority to us. As a courtesy to you, we try our best to deliver a reminder prior to your appointment. It is ultimately your responsibility to be on time and present for your appointment. We require 24 hours notice for all cancellations, unless an unavoidable circumstance prohibits your arrival, i.e. auto accident or medical emergency. Clients arriving more than 15 minutes late for a scheduled appointment will be considered a failed appointment and may need to be rescheduled. Our office reserves the right to charge $25.00 for any failed or inappropriately cancelled appointments. We require 72 hours notice for any surgery cancellations. There will be a charge of $100.00 for any missed or inappropriately cancelled surgeries. *

I understand

By initialing this box, I am acknowledging that I have read and understand the above policies *

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New Client Registration Form

Policies

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