New Client Form

You can submit our “New Client Form” in two ways:
1) Fill out and print our New Client Form here. Bring the form printed and filled out or emailed for your visit.
2) Fill out our form online:

New Client Form

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Referred By *

Pet Name *

Age/Birthdate *

Sex *

Male Female

Spayed/Neutered *

Yes No

Breed *

Color *

We accept credit cards, debit cards and cash. Please visit our website (www.mountainviewvethospital.com) for details on all of our hospital policies. As a pet guardian, you will be held liable for the financial responsibility of services that are performed for each pet. Unpaid balances will be recovered as deemed appropriate and may incur a $30.00 administration fee. A 1.5% monthly interest fee will be charged on all unpaid balances. *

I understand and abide by the above statements

I acknowledge that Mountain View Veterinary Hospital does not accept personal checks *

I acknowledge

Image Consent: We often use patient pictures for our website, Facebook, and Instagram. Your signature authorizes MVVH to use photographs and videos in print media, brochures, the MVVH website, and on social media outlets. You also agree not to file any claim for revenue, or lawsuit for damages, against this veterinary practice with respect to the release of this information. *

I consent I opt out

Entering Your Full Name Here Will Serve As Your Digital Signature: *

Date: *

Submit