New Client Form

520-833-2134

About Us
Services
In-Home Pet Euthanasia
New Client Form
Community Resources
- Grief Counseling
Contact
Online Pharmacy
In Clinic Prescription Refill
Review Us

Request Appointment

Mon-Fri 8:00AM-5:00PM | Sat & Sun CLOSED

info@desertpaws.com | Pay Invoice

520-833-2134

Locally Owned and Operated

520-833-2134

In Clinic Prescription Refill

Request Appointment

About Us
Services
In-Home Pet Euthanasia
New Client Form
Community Resources
- Grief Counseling
Contact
Online Pharmacy
In Clinic Prescription Refill
Review Us

New Client Form

Owner's Name *

Co-owner's Name

Address, city, state *

Zip Code *

Email Address *

Phone number *

Secondary phone number

Name and phone number of previous clinic

Preferred form of communication PhoneEmail

Place of current employment

How did you hear about us?

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Who can we thank? *

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Pet #1

SpeciesDogCat

Pet's Name

Pet's Breed

Pet's Color

Pet's Age

Pet's Sex

Does this animal have pet insurance? If so, what is the company and policy number?

Temperament

Pet #2

SpeciesDogCat

Pet's Name

Pet's Breed

Pet's Color

Pet's Age

Pet's Sex

Does this animal have pet insurance? If so, what is the company and policy number?

Temperament

Pet #3

SpeciesDogCat

Pet's Name

Pet's Breed

Pet's Color

Pet's Age

Pet's Sex

Does this animal have pet insurance? If so, what is the company and policy number?

Temperament

Pet #4

SpeciesDogCat

Pet's Name

Pet's Breed

Pet's Color

Pet's Age

Pet's Sex

Does this animal have pet insurance? If so, what is the company and policy number?

Temperament

Do we have permission to use your pet's picture on our website and social media?YesNo

PLEASE READ - FINANCIAL RESPONSIBILITY

For your convenience, we will accept payment in the form of Cash, Check, Visa, Mastercard, American Express and Discover. By submitting this form, I agree I am responsible for any charges incurred by my pet and that payment is due at the time of service. Delinquent accounts will be assessed interest at a rate of 18% per annum. Should it become necessary to place a delinquent account with a collection agency, a collection fee of up to 35% of the principal balance due will be added to defray the cost of collection. Additionally, if legal action is necessary to collect the delinquent account I/we understand that I/we will be responsible for all costs of collection to include but not limited to court costs, interest, and attorney fees. In any of these events, a credit report may be pulled.

ALSO NOTE

If during your appointment, your pet(s) are unable to be examined due to temperament, a call fee and consultation fee will be charged so that we are able to legally give recommendations, and possibly prescribe medication for future visits should they need it.

Authorized Signer *

Printed Name *

Date *