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 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 policies and check that you have read and you understand and agree to them. Failure to agree to these policies will disqualify you from becoming a client at our clinic.

Treatment Authorization

I hereby authorize the veterinarian to examine, prescribe medication for, and/or treat my pet and I assume full responsibility for all charges incurred by doing so. I understand I can ask for a treatment plan ahead of time, decline any services I wish to decline, and terminate my relationship with Evans Animal Hospital by notifying any member of the staff.

Please check: *

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

Financial 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. There is a $30 fee for all returned checks. Upon request, we will gladly prepare an estimate for services prior to treatment.

Please check: *

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

Privacy Policy

With respect to client/patient confidentiality, we require you to inform us of any person(s) who is permitted to have access to your pet's medical record. This includes your pet's current status, prior medical history, or making decisions for future care. In the box below, please list the names of the person(s), other than those listed on the account, who have your permission to access your pet's medical record. We will only provide vaccination status to groomer's and kennels upon request.

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: *

Social Media

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

Choose one: *

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 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.