New Client Form Please fill out our new client form before your first visit. We look forward to meeting you and your pet. Owner's Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### How did you hear about us? Select One Google Search Social Media Referral Other Pet's Name * Species * Canine Feline Breed * Approximate Date of Birth * MM DD YYYY Sex * Male Female Spayed/Neutered * Yes No Name of clinic where records can be obtained * Who is your current pet insurance provider? Do you qualify for our ‘Senior Discount’? Please check the box if you’re 60 years or older. Yes No Authorization and Consent I understand that full payment must be made at the time veterinary services are provided. I authorize Nimbus Pet Hospital to administer treatment and diagnostics as necessary. I also understand I am responsible for all charges incurred for the care of my animal. I give Nimbus Pet Hospital permission to post photos and/or videos of my pet on social media or on the Nimbus Pet Hospital website. Thank you! Our staff will contact you soon to schedule an appointment.
