New Client Form

We can’t wait to meet your pet!

Fill out your form online or download it and bring it with you to your visit.

Download PDF

dots
dots

"*" indicates required fields

Pet Owner Information

Owner:**
Address:**

Patient Information

Please Note Our Hospital’s Financial Policies

Payment is due in full at conclusion of visit/service. WE DO NOT BILL. Credit or payment plans must be obtained by owner through their bank or lending association.

We do accept Care Credit. Shenandoah Veterinary Hospital DOES NOT Extend Credit or Arrange Payment Terms.

** All hospitalization and surgical procedure estimates are to be paid in advance **

I understand that failure to pay will result in full collection effort being taken and I will be responsible for all collection costs, including, but not limited to: Court Costs, Serving by private processor or sheriff, and any other fees incurred.

I understand that there is a returned check fee of $30.00

Shenandoah Veterinary Hospital offers Premium veterinary care at reasonable prices.

Our failure to enforce our financial policies would most definitely result in significantly increased costs of veterinary care.

We sincerely hope you understand these policies. We are enforcing these policies in order to keep your veterinary medical expenses within reasonable limits.

Statement of Acceptance

I have read the above referenced policies. I understand them completely and hereby give notice of my intention to fully adhere to their provisions.
Owner/ Agent Signature:**
This field is for validation purposes and should be left unchanged.