New Client Form

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If you are new to Larkspur Cat Clinic, please complete the following "New Client Form" and submit it. This will help expedite your visit to Larkspur Cat Clinic.

 

*Owners Name:
Spouse/Other's Name:
*Date of Birth:
*Address:
*City:
*State:
*Zip Code:
*Owner's Home Phone:
Owner's Work Phone:
Owner's Cell Phone:
*Owner's Email Address:
Spouse/Other's Work Phone:
Spouse/Other's Cell Phone:
*At what time and number is it best to call about your cat?
- Time:
- Number:
*Emergency Contact
- Who:
- Number:

How did you hear
of our hospital?

If Indivual, Whom may we thank?
*I understand that I will be expected to pay for services at the time of each visit. I further agree to pay for all finance charges, collection fees, and other costs that may be incurred to enforce collection on any amounts outstanding. I authorize the doctors and staff to perform life saving treatments in the event I cannot be reached. I release forever, the veterinarians, staff, agents and/or representatives of Larkspur Cat Clinic from any and all liability associated with treatments, procedures or surgeries performed there.

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