Patient's name required
Client / Owner Information
Name required
Enter spouse/co-owner name
Enter address
Enter phone number 
Enter cellphone number 
Enter work phone number
Enter spouse/co-owner phone
Email required
Select how you heard about us
About Your First Pet
Enter first pet name
Enter pet breed
Select first pet type
Select first pet sex
Select first pet spayed/neutered
Enter first pet color
Enter first pet age
Enter second pet name
Select second pet type
Select second pet sex
Select second pet spayed/neutered
Enter second pet color
Enter second pet age
Does your pet have any known drug or food allergies?

WINDAN’SEA VETERINARY CLINIC POLICY

Payment is due at time of services.  We accept VISA,MC, AMEX, Discover, CareCredit, Cash, and checks.There is a $25.00fee for returned checks.  We do not offer any billingservice.  If you need financial assistance, pleaseask us aboutCareCredit.

Owner Release:  Windan’Sea Veterinary Clinic is touse all reasonable precautions against injury, escape,illness or death ofmy pet.  The clinic and staff will not be held liablefor any problems that develop, provided reasonablecare and precautionsare followed.  I understand that any problem thatdevelops with my pet while I am absent or unable tobe contacted, will betreated as deemed best by Dr. Raichel or relief doctors,and I assume full responsibility for the treatmentexpense involved.

I HAVE READ THIS POLICY AND AGREE TO THESE TERMS

Sign above