Galax Veterinary Clinic

New Client Form

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Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Payment is due in full at the time that services are performed. If being admitted into the hospital, 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 50% of the upper 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 Cash, Visa, MasterCard, Discover, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

I grant permission to Animal Medical Services, its representatives, and employees to take pictures to use for marketing and promotional purposes. *

I grant permission
I do not grant permission

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We proudly serve pets in Galax, VA, and beyond.

It is our mission to partner with our clients to nurture and preserve the human-animal bond by providing compassionate, expert, and affordable veterinary care from your pet’s first adventure throughout a long and healthy life.

Galax Veterinary Clinic

New Client Form

We proudly serve pets in Galax, VA, and beyond.

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24-Hour Emergency Services Available for Your Pet

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