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New Client Form

We Love Meeting New Clients and Their Pets!

To make your first visit stress-free, simply fill out the form below or download it and bring it with you. We can’t wait to welcome you into our community!

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New/Updated Client Information Form

LinkedIn

This field is for validation purposes and should be left unchanged.

Pet Owner Information

Your Name:(Required)

First Name Last Name

Co-Owner (if applicable)

First Name Last Name

Primary Client Date of Birth:(Required)

MM slash DD slash YYYY

Primary Client Driver's License or SSN:(Required)

Primary Phone Number(Required)

Secondary Phone Number

Primary Email(Required)

Address:*(Required)

Street Address City State Zip Code

What is your preferred method of communication with our office?(Required)

Text

Call

Email

Mail

Other

Would you like to be contacted to schedule an appointment for your pet?(Required)

Yes

No, not at this time

How did you hear about us? (Give a name if a client referred you!)

Pet Information

Pet's Name

List

Pet Name

Species/Breed

Birthday/Age

Color/Markings

Gender (Spay/Neuter)

Prior Veterinarian

Current Medications

Important History

Policies and Release

Payment Policy(Required)

I agree to the payment policy

Payment is due in full at the time services are rendered. For your convenience, we accept all major credit cards, cash, CareCredit, and Scratchpay.

Failure to pay for any services rendered by Indy Paws Veterinary Hospital will result in client responsibility of any attorney fees or court costs incurred by the hospital.

Missed Appointments/Cancellations(Required)

I agree to the missed appointments/cancellations policy

In order to best serve you and prevent appointment delays, we request that you arrive within 5 minutes of your appointment time. If you are more than 5 minutes late, your appointment may be forfeited and we may request that you reschedule your appointment.

We understand that circumstances may come up that will make it necessary to cancel an appointment or a surgery. Missed appointments represent a loss to us, to you and your pet, and to other patients who could have been seen in the time set aside for you. Cancellations or rescheduling must be made at least 24 business hours before the scheduled appointment. If you do not give us that notice, we will require a non-refundable, deposit to schedule your next appointment and future appointments.

Social Media Release

I agree to participate in the social media policy.

At Indy Paws Veterinary Hospital, we love our patients and clients, and enjoy sharing pictures and stories of your amazing pets!

By acknowledging our social media policy, you authorize Indy Paws Veterinary Hospital and its representatives to share and post pictures of your pet(s) to Indy Paws Veterinary Hospital’s social media including, but not limited to, Facebook, Twitter, Instagram, for display, public relations, and marketing.

I acknowledge receipt of adequate consideration and waive the right to charge for use of my pictures and my name, or to inspect or approve the images prior to any form of usage. I understand the images may be modified to be used as design elements.

Consent

I agree

I certify that I am the owner or authorized agent of the pet(s) listed above. I am confirming that the information provided above is true to the best of my knowledge.

Email Consent

I agree to receive email communications.

I agree to receive marketing offers and updates via your preferred/primary email. You'll still receive services and account related emails if you do not check the box.

SMS Consent

I agree to receive SMS communications.

I agree to receive recurring automated messages about pet care, appointment reminders, marketing communications, and offers to the mobile number provided. Your consent is not required, and you may opt out at any time by replying STOP. Msg & data rates may apply. Message frequency may vary.

Electronic Age Consent

I agree

Checking the “I Agree” box indicates that:
I certify that I am at least 18 years old and legally permitted to provide this information.

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Our Practice
VIPet Plan
- Enroll
Services
New Clients
- New Client Form
Resources
Contact Us

Our Practice
VIPet Plan
- Enroll
Services
New Clients
- New Client Form
Resources
Contact Us

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