Client Registration Form at Healing Arts Veterinary Center

New to our clinic? Start here! Fill out our client registration form to join the Healing Arts Veterinary Center family.

Get Started

Get Started as a New Client at Healing Arts Veterinary Center

Complete The Form

Owner's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone (Cell) *

Phone (Work)

Phone (Home)

Email *

previous Color vaccines,

Preferred Method of Contact *

Occupation / Employer’s Name

Co-Owner

Phone

How did you hear about us?

Pet's Name *

Breed

Date of Birth

Color

Male/Female *

Male
Female

Spayed/Neutered *

Yes
No

Microchip

Allergic to:

List any medication that your pet is currently taking:

List the most current vaccines, dates and previous clinic:

The undersigned owner/agent hereby authorizes the staff and doctors of Healing Arts Veterinary Center to provide services to this pet and acknowledges that payment in full for the care and treatment of their animal is due at the time services are rendered. A deposit may be required prior to treatment. Should it become necessary for Healing Arts Veterinary Center to collect payment through a collection agency or attorney, the undersigned agrees to pay all costs of collection, including collection fees, attorney’s fees, court costs, and any related expenses. Please note that guarantees and warranties cannot be offered in veterinary care.

Owner / Agent Name *

Owner / Agent Signature *

Clear Signature

Today's Date *

Client Registration Form at Healing Arts Veterinary Center

Get Started as a New Client at Healing Arts Veterinary Center

Complete The Form

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