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

Last

Pronoun Preference

Secondary Owner's Name

First

Last

Pronoun Preference (copy)

Address Line 1 *

Address Line 2

scheduled can about

City *

State *

ZIP Code *

Email *

Phone *

How did you hear about us?

Pet's Name *

Species *

Breed *

Approximate Date of Birth *

Sex *

Spayed/Neutered *

Do you currently have an appointment scheduled with us? *

Name of clinic where records can be obtained *

Who is your current pet insurance provider?

Are you interested in signing up for our Wellness Plan?

Do you qualify for our ‘Senior Discount’? Please check the box if you’re 60 years or older.

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.

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