I am a:*

New Client With A New Patient
Returning Client With A New Patient

Client Name:*

First Last

Employer:*

Occupation:*

Spouse's Name:

First Last

Spouse's Employer:

Spouse's Occupation::

Mailing Address:*

Street Address City State ZIP Code

Cell Phone:*

Home Phone:

Work Phone:

Spouse Phone:

Email*

Is there anyone else you would like to add to the account that could have access to your pets healthcare information (family member, pet sitter, etc)?

Name:

First Last

Contact Number:

Relationship to you or your pet:

Additional Information

Do you wish to make Mountain View Animal Hospital & Holistic Pet Care your primary practice?*

Yes
No

Name of your previous primary veterinary practice:*

Do you have a copy of your pet's medical records?*

Yes
No

Upload a copy of your pet's medical records:

Max. file size: 250 MB.

How did you hear about us?*

If Existing Client/Employee please list their name:*

First Last

If Community Event please list the event:*

It is important to us as an integrative animal hospital to understand how you would like us to discuss healthcare options for your pet. How much of a Holistic (natural) approach do you prefer in your pet's health? (1 being the lowest; 5 being the highest):

Please enter a number from 1 to 5.

Treatment Consent

I, the owner of the patient(s), hereby authorize the veterinarians and staff of Mountain View Animal Hospital & Holistic Pet Care to examine, treat, and prescribe necessary medication for the above listed pet. This includes, but is not limited to, procedures therapeutically and/or diagnostically. I understand that no guarantee of successful treatment is made. I further understand that this facility has a doctor on staff between 7:30am to 5:30pm only, therefore, there is no continuous presence of doctors after regular business hours. I certify that all the information above is correct, that I am the rightful owner or authorized agent of this pet(s) and that I am at least 18 years of age. Mountain View Animal Hospital & Holistic Pet Care does not operate as an emergency hospital and although we will always try to be available, I understand I may be referred to an emergency hospital even during open hours if we feel it is best for my pet(s).

I understand by Nevada pharmaceutical law, all prescriptions including herbals that leave the hospital are non-refundable, even if my pet(s) has a reaction.

Payment Policy

Please note: All fees incurred at Mountain View Animal Hospital & Holistic Pet Care are required to be paid upon time of service. We do not accept payment plans or delayed billing. Any unpaid balance left unpaid are subject to accrued 1.5% interest after 30 days, and balances left unpaid for more than 90 days will be sent to collections in addition to a 40% collection fee. There is a $35 charge for each returned check, and we do not accept any postdated checks.

We accept Visa, Mastercard, American Express, CareCredit & for established clients (with a least 2 previous visits) we also accept checks.

Cancellation Policy

We request that any cancellations be made at least 24 hours prior to the start of your pet's medical appointment, grooming appointment or boarding/daycare reservation. If you cancel without ample notice or do not show up to your appointment or boarding/daycare reservation you may be required to pay a cancellation fee. This fee is non-refundable and cannot be applied toward any other services.

I have read, understand and accept all the information above.

Electronic Communication Disclaimer

Mountain View Animal Hospital & Holistic Pet Care offers client communication through email, calls, and texts. If you choose to text our office, you are entering into the agreement detailed below.

By enrolling in our texting program, you are authorizing our office; Mountain View Animal Hospital & Holistic Pet Care, to send text messages to you on your provided cell phone number. You certify you are the person who is legally responsible for all use of the accounts, and are at least 18 years of age or older, and have agreed to all terms and conditions of use for the text messaging services. You understand that you can reply to confirm appointments, make future appointments, and get office location, office hours, and other alerts /information. Text message charges from your cell phone carrier may apply.

Mountain View Animal Hospital & Holistic Pet Care offers a text messaging system to our current clients for the following:

Appointment confirmations and other services and content deemed appropriate. By opting-in our text messaging program, you are providing consent for us to reach you via text for confirmation, cancelations, rescheduling, office closing, follow-ups, and any other forms of communication. Data and message rates may apply so please contact your cell phone carrier for additional information regarding your text messaging plan/coverage.

Signature*

Date*

Client Forms

Step 1 of 3

Electronic Communication Disclaimer