Owner Information
Spouse
Are we permitted to call you at work?
Would you like to receive appointment and care reminders via text message?
Would you like to receive appointment and care reminders via email?
How did you hear about us? (Please check all that apply)

As a client of Family Pet Veterinary centers you acknowledge that all payment is due when services are rendered. You also understand that your account balance will be doubled if this account is assigned to an
agency for collections. There is a $30.00 charge for each/any returned check and are subject to prosecution by the district attorney’s office. When paying by check a valid driver’s license must be presented.

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Pet Information
Sex
(please check one)
Does your pet get any treats (including human food)?
Pet Questionnaire:
Does your pet chew on any of the following? (Please check all that apply.)
Are you currently using any homecare for your pet’s teeth?
If yes, which products:(please check all that apply)

Please Let us know if you or anyone in your family has allergies to cheese, peanuts, etc. We use treats in our clinic and don’t want to make anyone sick!