New Client Form at Altavista Animal Clinic

Please read carefully; a signature is required before examination or treatment will be given.

I certify that I am at least eighteen (18) years of age and am the owner or authorized agent for the pet(s) listed on this form. I further understand that I am responsible for all fees associated with my pet’s treatment and that payment is kindly expected at the time of service. Altavista Animal Clinic accepts cash, checks, debit, Visa, Mastercard, Discover, American Express, Cherry, and CareCredit. They do not offer billing, and there is a $35 fee for checks returned unpaid. If I have any concerns regarding payment today, I may speak with the team or the doctor before my pet’s treatment begins.

On occasion, I or my pet’s likeness may be captured on video, photographs, or other media. I hereby authorize and grant to Altavista Animal Clinic and its affiliates a perpetual, royalty-free license to publish, distribute, use, broadcast, adapt, or otherwise use such media for any commercial or non-commercial purpose. I understand I will not be compensated for any such use nor will I receive prior notice of any such use.

While Altavista Animal Clinic will try to contact me by the preferred method listed above I consent to receiving communications from them by email, phone, and text messages as needed.

Thank you for trusting us with your veterinary care. We are delighted to welcome you and your pet to our family!