Larkspur Cat Clinic

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:

*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.