New Clients Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together. Click here to download the form. Client InformationName* First Last Address* Street Address County (Please enter the county where you reside in your state) City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Phone*Email* Emergency/Second Contact Name* First Last Emergency/Second Contact Phone*Employer How did you here from us / who were you referred by? Previous Veterinary Clinic (Name, City, Phone):Pet InformationPet's Name* Sex* Male Male – neutered Female Female – spayed Species* Cat Dog Species* Cat Dog Breed* Color* Birthday (or best estimate)* MM slash DD slash YYYY Please List Any Known Medical Conditions or Allergies:*Flea/Tick Medication (if applicable): Date Last Given:* MM slash DD slash YYYY Heartworm Medication (if applicable): Date Last Given: MM slash DD slash YYYY Other Medications (Name, Dosage, How Often):Add another pet?* Yes No Pet #2Pet's Name* Sex* Male Male – neutered Female Female – spayed Species* Cat Dog Breed* Color* Birthday (or best estimate)* MM slash DD slash YYYY Please List Any Known Medical Conditions or Allergies:*Flea/Tick Medication (if applicable): Date Last Given:* MM slash DD slash YYYY Heartworm Medication (if applicable): Date Last Given: MM slash DD slash YYYY Other Medications (Name, Dosage, How Often):Add a third pet?* Yes No Pet #3Pet's Name* Sex* Male Male – neutered Female Female – spayed Species* Cat Dog Breed* Color* Birthday (or best estimate)* MM slash DD slash YYYY Please List Any Known Medical Conditions or Allergies:*Flea/Tick Medication (if applicable): Date Last Given:* MM slash DD slash YYYY Heartworm Medication (if applicable): Date Last Given: MM slash DD slash YYYY Other Medications (Name, Dosage, How Often):Financial Policy Sycamore Veterinary Services requires full payment of services at the time of treatment. We Accept Cash, Debit Cards, Most Credit Cards, and Scratch Pay. By signing below you are agreeing to pay all charges when services are rendered. Cancellation Policy If you have missed more than 2 appointments we will require a $25.00 deposit that will be credited towards your bill when you come in, but is forfeited if you miss your appointment or fail to reschedule within 24 hours. For surgeries, the deposit will be $50.00 and again, it will be credited towards your total bill. We DO NOT accept personal checks. Signature*We enjoy showing off your pets on our website, Facebook, and Instagram! Please let us know whether or not we may use photos and videos of your pet. Yes No CAPTCHA Δ
