New Client / Patient Form (Dogs, Cats, Goats, Other)

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*PLEASE INFORM US RIGHT AWAY IF YOUR PET IS NERVOUS, AGGRESSIVE OR DOES NOT DO WELL WITH OTHER ANIMALS*

First and Last Name *

Street Address, City, State, Zip Code *

Phone Number (List as many as you'd like, with contact names) *

Email Address *

Pet Name # 1 - Please list breed, age/date of birth, color and sex (Female/Male/Spayed/Neutered) *

Pet Name # 2 - Please list breed, age/date of birth, color and sex (Female/Male/Spayed/Neutered)

Pet Name # 3 - Please list breed, age/date of birth, color and sex (Female/Male/Spayed/Neutered)

Pet Name # 4 - Please list breed, age/date of birth, color and sex (Female/Male/Spayed/Neutered)

If your pet has any things to be cautious about such as: Fear, aggression, biting, does not like other animals, etc. Please list so that we can be prepared.

Is your pet on any current medications? If so, please list.

Previous Vet Records

If you have previous vet records on your pet we must have them prior to their first visit with us. If we do not have your pets previous records prior to their first appointment, we may have to reschedule your pets appointment. Please contact your previous vet and have them sent to us as soon as possible. Previous records can be sent to Kernroadvet@gmail.com or via Fax 517-223-0101.

CLINIC POLICIES

Financial Policy: Payment is due at the time of your appointment. We do not offer payment plans. We do accept cash, checks, Care Credit and all major credit cards. A $35 fee will be billed for any returned checks.

Running Late or Missed Appointment Policy: If you are running late to your appointment, please call us to inform us. If you are running more than 10 minutes late, a late fee of $20 will be applied and it is up to your doctor if they can still see your pet or if they need you to reschedule. Your first missed appointment will result in a phone call, with no charge. Your second missed appointment will result in a $50 charge. Any appointments missed thereafter will require a deposit to schedule future appointments.

Social Media Policy: We occasionally share photos of our patients via our Facebook/Instagram. If you prefer we do not share photos of your pet please let staff know so that we can note that in your account.

By selecting "Yes" you have read and agree to our clinic policies. If for any reason you do not agree to our policies, please call the office to discuss. *

Yes

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