New Client Form

Save time at your first appointment. Complete your new client form online before your visit.

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Contact Name *

First

Last

Contact Address *

Address Line 1

Address Line 2

City

State

Zip Code

Contact Date of Birth *

Contact Phone Number

Cell Phone

Contact Email Address *

Spouse/Other Name

First

Last

Spouse/other's phone number

Pet Information

Pet's Name *

Select Pet Species

Pet Breed

Pet Birthdate

Color/Markings

If you have another pet you’d like to share with us, please let us know and we are happy to send you a separate link for an “Additional Pet” Form.

Records for previous vaccination and medical history may be obtained at:

Please note: It is the client's responsibility to ensure that the patient's previous medical records are received PRIOR to arrival for their first appointment. Records can be uploaded here or emailed to northbayreception2@gmail.com. If you don't have your own copies, please contact your previous veterinary clinic to have them sent by email, northbayreception2@gmail.com or by fax (850) 248-4740. Thank you for helping us prepare for your first visit!

Clinic Name/State:

Phone Number

Date of last vaccinations (if known):

Please upload previous records here. By providing these records in advance of your scheduled appointment, we are better able to prepare ahead of time to receive your pet. Alternatively, you may email records to northbayreception2@gmail.com or text them to (850) 303-6663. Please be sure to include your name, your patient's name and the date/time of your scheduled appointment. Choosing to wait until the day of your appointment to provide previous records or paperwork for your patient may result in a record preparation fee starting at $10.

How did you hear about us?

Releases and Disclosures

IMPORTANT and NECESSARY, but not a whole lot of fun. Please read and acknowledge the following:

I give permission to North Bay Animal Hospital to share my pets photos via email, Facebook and other forms of media

Payment is required at the time of service. *

Initials

North Bay Animal Hospital accepts payment by cash, check, Visa, Mastercard, Discover, American Express and UPON APPROVAL, CareCredit and Scratch Pay. *

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North Bay Animal Hospital strives to keep our appointment times. To help us, we ask you to arrive at least 10 minutes prior to your FIRST appointment and five minutes early to all other appointments. *

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One business day’s notice is required for appointment cancelations. To cancel or reschedule, please call (850) 265-9435 or text (850) 303-6663 during business hours. *

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Missed appointments or late cancellations may result in a $25 no-show fee applied to your account. *

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Our office hours are Monday-Friday, 8:00 AM-5:30 PM. We provide emergency after hours clinic information on our premises, our after hours voice mail and our facebook page. At your request, we can provide you with an emailed or printed copy of these resources to keep at the ready. We accept calls, texts and emails during working hours only. *

Initials

We choose to engage our clients with respect and fully expect the respect to be mutual. We will not tolerate any disrespect or abuse in either direction. Failure to do so may result in termination of our Veterinary-Client-Patient-Relationship. *

Initials

Our priority at North Bay Animal Hospital is to provide you and your pets with great care and compassion. Thank you for choosing to join our veterinary family!

I attest that I am 18 years of age or older and have the authority to make medical decisions for this pet.

Signature *

Clear Signature

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Date

Message

New Client Form

New Client Form

Pet Information

Ready to Visit?

Address

Get in Touch

Hours

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