Primary Contact

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Primary Phone *

Email address *

Employer *

Secondary Contact

Name

First

Last

Phone

Employer

I grant Parvin Animal Clinic permission to use my pet’s pictures, medical information, and story on social media. *

Yes
No

How did you hear about our hospital?

Whom may we thank?

Pet Information

the Would and

Pet's Name *

Sex *

Male
Neutered Male
Female
Spayed Female

Species *

Dog
Cat

Pet's Date of Birth *

Breed *

Color *

Microchipped? *

Yes
No

What is the microchip number?

Would you like to add a second pet? *

Yes
No

Pet's Name *

Sex *

Male
Neutered Male
Female
Spayed Female

Species *

Dog
Cat

Pet's Date of Birth *

Breed *

Color *

Microchipped? *

Yes
No

What is the microchip number?

Would you like to add a third pet? *

Yes
No

Pet's Name *

Sex *

Male
Neutered Male
Female
Spayed Female

Species *

Dog
Cat

Pet's Date of Birth *

Breed *

Color *

Microchipped? *

Yes
No

What is the microchip number?

Do your pet(s) have any allergies, special medications, or health problems we should know about? *

Yes
No

Please specify.

What type of food do your pet(s) eat? *

Treats?

Are your pets on heartworm preventatives? *

Yes
No

Which one?

Last date given?

Are your pets on flea prevention? *

Yes
No

Which one?

Last date given?

Previous Veterinary Records

Previous veterinary clinic(s) where medical/vaccine records can be obtained

Phone

Upload files here (PDF, JPG, PNG)

Drag & Drop Files, Choose Files to Upload

Or email records to: Parvinanimalclinic@gmail.com

Appointment, Cancellation & Payment Policies

In order to provide exceptional service to our clients and their families, our office implements a cancellation and no-show policy. Parvin Animal Clinic requests at least a 48-hour (2 business days) notice of changes or cancellations to scheduled surgeries, dental procedures, and ultrasounds. We request at least a 24-hour (1 business day) notice of any changes or cancellations to scheduled appointments. Changes outside of the above windows, late cancellations, or not showing for scheduled procedures and/or appointments may result in a charge. As a courtesy to our clients and patients, we offer an automated confirmation system, by utilizing the contact information listed above.

Parvin Animal Clinic requires a deposit fee of $150.00 at the time of scheduling for all elective surgeries, dental procedures, and ultrasounds. All non-elective procedure deposits are varied based on the procedure required. This deposit reserves the patient’s slot for the desired date of his/her procedure and will be used towards the services rendered that day. In the event of a late cancellation/late reschedule and/or a no-show on the day of the procedure, this deposited will be forfeited.
All emergencies and/or hospitalization require a deposit of at least 50% of the estimated cost. This deposit is due at the time the patient is admitted and prior to any medical treatments taking place.

All services must be paid at the time services are rendered. Accepted forms of payment include:

Cash
Visa
MasterCard
Discover
American Express
CareCredit
Scratchpay

Date *

Owner’s Signature *

Clear Signature

New Client Form

New Client Form for Parvin Animal Clinic in Spanish Fort, AL

Primary Contact

Secondary Contact

Pet Information

Previous Veterinary Records

Appointment, Cancellation & Payment Policies

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