Client / Owner Information
How Did You Hear About Us?

All fees are due at the time services are rendered.

We accept Cash, Check, Visa, MasterCard, American Express, Discover & Care Credit.

I hereby authorize Checkout Veterinary and their employees to reasonably use any photographic images taken by them of my pets, my children and myself in print and internet formats with no compensation or consideration.

PLEASE SEE REVERSE SIDE FOR INFORMATION ABOUT YOUR PETS!

 

Patient Information

Thank You for giving us the opportunity to care for your pet.

To insure the best care possible, please take the time to fill in this form completely.

Patient 1
Co-Owner or Agent Information
Other than the owner(s) listed on the front page, are there any other persons to whom you give primary responsibility for the care of the patient(s)?
Sign above