Client Name (Owner of Pet) *

Email Address *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone *

Cell Phone

Work Phone

Secondary Contact

Relation

Secondary Phone

If the doctors or technicians need to contact you about your pet, do you prefer *

Home
Cell
Text

How do you wish to receive your pet’s reminders? *

Email
Phone Call
Text

Has your pet visited a previous veterinary hospital? *

Yes
No

Previous Veterinary Hospital *

Previous Veterinary Hospital Phone *

Was the pet under your current name? *

Yes
No

If NO, whose name was it under? *

How did you find out about our veterinary services?

If one of our clients referred you, who may we thank for referring you?

All Reminders are sent via text or email

In case of an emergency, if you are unable to be present or unable to be reached, please list an authorized person able to make MEDICAL and FINANCIAL decisions for your pet(s). MEDICAL/FINANCIAL: *

I allow Goose Creek Veterinary clinic to use my pet(s) photos on any form of social media. *

Yes
No

NO-SHOW/LATE POLICY

We reserve the right to reschedule appointments for those who arrive 10 or more minutes late to their scheduled appointment. We respectfully request at least a 3-hour notice for all cancellations or rescheduled appointments. Appointments that are not cancelled or rescheduled at least 3-hours in advance are subject to a NON-REFUNDABLE fee of $72. No-shows are subject to the same fee. Every effort will be made by our staff to make reminder calls. However, it is the responsibility of the owner to keep track of all scheduled appointments.

PAYMENT POLICY

Full payment is due at the time of service. We do not offer delayed billing or payment arrangements. For your convenience, we accept Visa, MasterCard, American Express, Discover, Apple Pay, Trupanion, ScratchPay and CareCredit. We do not accept checks. We will be glad to provide you with a written treatment plan for all services rendered.

Every pet’s health is important to us and appointments fill up quickly. We feel these policies are necessary to ensure that every pet has the opportunity to be seen in a timely manner.

I have read, understand and agree to the policy information provided above.

Client Signature *

Clear Signature

Date *

Pet Information

Pet's Name *

Species *

Canine
Feline

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Male Neutered
Female
Female Spayed

Microchipped *

Yes
No

Has your pet had a vaccine reaction? *

Yes
No

Does this pet have pet insurance? *

Yes
No

Who is your pet's insurance provider? *

Please list any previous or current medical conditions, special medications or special diets.

Want to add second pet info? *

Yes
No

Pet's Name *

Species *

Canine
Feline

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Male Neutered
Female
Female Spayed

Microchipped *

Yes
No

Has your pet had a vaccine reaction? *

Yes
No

Does this pet have pet insurance? *

Yes
No

Who is your pet's insurance provider? *

Please list any previous or current medical conditions, special medications or special diets.

Want to add third pet info? *

Yes
No

Pet's Name *

Specie *

Canine
Feline

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Male Neutered
Female
Female Spayed

Microchipped *

Yes
No

Has your pet had a vaccine reaction? *

Yes
No

Does this pet have pet insurance? *

Yes
No

Who is your pet's insurance provider? *

Please list any previous or current medical conditions, special medications or special diets.

Welcoming new clients!

New Client Form

New Client Form

NO-SHOW/LATE POLICY

PAYMENT POLICY

Pet Information

Ready to visit?

Location

Contact Information

Hours

We proudly serve the pets of Goose Creek, SC and beyond