New Client Form

We like to make sure we have everything correct! Please fill out this form so we can double check your account for accuracy when you arrive. This form will also allow you to upload your medical records.

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New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Client Information

Name of primary contact *

First

Last

Name of secondary contact

First

Last

Relationship to primary contact

Primary phone number/type/who does number belong to *

Can receive text *

Secondary phone number/type/who does number belong to

Can receive text

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

If I am not the owner, who is?

Other parties allowed to make medical decisions or receive patient updates

Patient Information

Name *

Species *

Breed *

Sex/alteration *

Age/DOB *

rDVM *

Upload all primary vet records, including lab results and imaging.

Click or drag files to this area to upload. You can upload up to 5 files.

If you can’t do an upload on the website, then have them email all records to office@acesvetmed.com.

Payment is due in full at the time that services are performed. If being admitted into the hospital for advanced imaging, endoscopy or surgery, we cannot begin the care of your pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 100% of the low end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your pet. We accept credit cards, cash, personal checks up to $500, CareCredit, and Scratch Pay. We neither extend credit nor bill for services. *

I have read and accept the financial policy.

Client Signature *

Clear Signature

Date *

Name

Forms

New Client Form

New Client Form

Client Information

Patient Information

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Contact Information

Location

Hours