New Client Form

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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. If this is an emergency, or if your pet needs urgent care, please call us at 208-233-6840 for a faster response.

Owner's Name *

First

Last

Name of person responsible for medical and financial decisions about the patient.

Spouse/Partner Name

First

Last

Please provide the name of anyone you would like to authorize to make medical/financial decisions regarding the patient.

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Email *

Please provide a current email address

Do you wish to receive email reminders about your pet? *

Emergency Contact *

First

Last

Person(s) authorized to make decisions (medical & financial) about your pets if we are unable to reach you during an emergency.

Emergency Contact Phone *

How did you hear about us?

Friend
Facebook
Instagram
Website
Google
Sign
Newspaper

Name of friend we should thank for the referral

Pet's Name *

Species *

Sex *

Female
Male
I don't know

Is patient altered or unsexed? *

Spayed
Neutered
Neither
I don't know

Patient's Breed *

What color is patient? *

Patient's Age *

Please provide approximate age, or exact date of birth if you know it.

We want your pet to be Facebook famous, but we need your permission first. I grant permission to Community Animal Hospital, it's employees and authorized representatives to take photographs and/or video of me and/or my pet(s), to copyright, use and publish the same in print and/or electronically. Community Animal Hospital may also use and publish my pet's story, including relevant medical history. I agree that Community Animal Hospital may use such photographs, videos or stories including me and/or my pet with or without our names and for any lawful purpose, including for example such purposes as social media, publicity advertising, and other web content. *

I accept
I don't accept

At Community Animal Hospital, our top priority is providing excellent quality care for your pet. We realize that finances to provide that care may be a concern and we are committed to providing options that make veterinary care more accessible. PAYMENT IS DUE AT TIME OF SERVICE. IF YOU ARE UNABLE TO PAY TODAY, PLEASE DISCUSS OPTIONS WITH OUR STAFF PRIOR TO YOUR APPOINTMENT. Payment types accepted: cash, checks, Visa, Mastercard, Discover, American Express, Carecredit, Scratchpay, Applepay, and gift cards issued by our hospital. Carecredit and Scratchpay MUST BE APPROVED IN ADVANCE of any services rendered. A$20 fee will be assessed for any returned checks. *

I accept
I don't accept

We provide written treatment plans for any procedure upon request. Treatment plans approximate total costs as closely as possible, however the final invoice may vary from the treatment plan. Treatment plan is only valid for 30 days. Deposits may be required for hospitalization, emergency care, or any extensive care, for up to 75% of estimated costs for treatment. The remaining balance will be due at the time of discharge from the hospital. *

I accept
I don't accept

Come in for superior care and excellent service.

We have a state of the art veterinary facility which is clean, comfortable, and efficient. Call (208) 233-6840 to book an appointment or click on the button below and we will find a time that is convenient for you.

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