New Client Form Please fill out our new client form before your first visit. We look forward to meeting you and your pet. Owner's Name * First Name Last Name Pronoun Preference She/Her He/Him They/Them Secondary Owner's Name First Name Last Name Pronoun Preference She/Her He/Him They/Them Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### How did you hear about us? Select One Google Search Social Media Referral Other Pet's Name * Species * Canine Feline Breed * Approximate Date of Birth * MM DD YYYY Sex * Male Female Spayed/Neutered * Yes No Do you currently have an appointment scheduled with us? * Yes No Name of clinic where records can be obtained * Who is your current pet insurance provider? Are you interested in signing up for our Wellness Plan? Yes No Do you qualify for our ‘Senior Discount’? Please check the box if you’re 60 years or older. Yes No Authorization and Consent I understand that full payment must be made at the time veterinary services are provided. I authorize Nimbus Pet Hospital to administer treatment and diagnostics as necessary. I also understand I am responsible for all charges incurred for the care of my animal. I give Nimbus Pet Hospital permission to post photos and/or videos of my pet on social media or on the Nimbus Pet Hospital website. Thank you for submitting our New Client Form. Please continue to our Fear Free Questionnaire. If you do not have an appointment scheduled our team will reach out to you shortly.
