New Client Information

Welcome to Our New Clients!

Evans Animal Hospital welcomes you and your pets! If you are new to the area or just searching for the right veterinarian for your pets, please feel free to call our office or stop by to discuss your pet's needs. Our hours are listed on the bottom of our home page. In an effort to minimize your wait time, please fill out the New Client Information Form below and submit your information online. You will also need to submit a separate new patient form for each pet. We look forward to meeting you and your pets!

Contact Information

* Indicates required field

Primary Owner's Name *

First

Last

Secondary Owner's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Primary Phone Number *

Type of Phone *

Secondary Phone Number *

Type of Phone *

Employer *

Email *

How did you hear about us? *

If you were referred by a friend, please let us know who so we may thank them! *

Clinic Policies

We, at Evans Animal Hospital , pledge to provide the highest quality of veterinary medicine in a professional and compassionate environment. We highly value personal relationships with each pet and their owner. We maintain the health of our patients by using the most current diagnostics and treatments, placing an emphasis on client education and preventative medicine.

Please read the following statements carefully and check that you understand and agree to our policies. Failure to read and agree to these policies disqualifies you from becoming a client at our facility.

Treatment Authorization

I hereby authorize the veterinarian to examine, prescribe medicine for, and/or treat my pet and I assume full responsibility for all the charges incurred in doing so. I understand I can ask for a treatment plan ahead of time, discuss any future treatments, decline any treatments, and terminate treatment at any time by contacting the veterinarian or member of the team.

Please check *

I have read, I understand and agree to the treatment authorization

Payment Policy

Payment is due when services are rendered. For hospitalized cases, a deposit may be required in advance. The remaining balance is due upon discharge from the hospital. You may pay by cash, personal check (with proper identification), Visa, Mastercard, Discover, American Express, or Care Credit. We will gladly prepare an estimate for services, upon request. There is a $30 fee for all returned checks.

Please check *

I have read, I understand and agree to the payment policy.

Privacy Policy

Due to our client/patient confidentiality, we require you to provide us with the names of the person (s) allowed to access your pet's records. This includes people who are authorized to seek treatment, obtain medical status before, during, and after treatment, and access your pet's medical history. We will only provide vaccine status to boarding facilities or groomers. It is your responsibility to notify us if this information changes.

Please check: *

I have read, I understand and agree to the privacy policy.

Please list those people, other than you, who have permission to access your pet's medical records: *

Media Policy

Do we have permission to use your pet's image on social media such as Facebook, Twitter, etc? *

Yes No

Leash/Carrier Policy

I understand that my pet must remain on a leash or in a carrier at all times in the common areas of the clinic. If you are in need of a leash or a carrier, please notify the receptionist prior to bringing your pet into our facility.

Please check: *

I have read, I understand and agree to the leash/carrier policy.

Comments: *

Submit

Once you have submitted your information, please don't forget to fill out and submit your pet's information also.