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New Client Form

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Welcome to West Main Animal Hospital

Thank you for selecting our veterinary healthcare team!

We strive to provide your pet with the best possible care. To help us meet all your veterinary care needs, please fill out this form completely. If you have any questions or need assistance, we will be happy to help.

(must be over 18 years of age)
PET INFORMATION
OTHER PETS
MEDICAL HISTORY
ALL FEES ARE DUE AND PAYABLE UPON COMPLETION OF SERVICE

We accept cash, credit card (visa and mastercard), local check, and Care Credit as payment.

Payment in full is expected when treatment is performed or animal is discharged. In case of emergency hospitalization, deposit arrangements must be made with the practice owner. On your request, we will provide you with a written estimate of fees before care is provided. Accounts carried over 30 days will be charged 1.5% per month/min $5.00. Accounts turned over for collection will have a $50.00 fee added. Any returned checks are subject to an additional $35 fee on your account.
Signature of Responsible party