New Client Form

Please fill out this form 48 hours prior to your appointment

    Client Information
    Pet Information
    How Did You Hear About Us?
    By letting us know who referred you we can properly thank them.
    FEES ARE DUE AT THE TIME SERVICES ARE RENDERED
    We will gladly prepare a written estimate if you desire. Estimates are made in good faith. We will do our best to stay as close as possible to estimated charges. Unpredictable costs do occasionally occur and will be the responsibility of the client. If you would like a written estimate prepared, please ask someone on our staff. We accept cash, Visa, MasterCard, Discover, American Express, and Care Credit®. Checks are not accepted on first visits. Checks will be accepted on subsequent visits with Texas Drivers License. No temporary checks will be accepted. A fee of $35.00 will be charged on all returned checks. It is your responsibility to update your account in the event of a returned check. If arrangements are not made to update your account, we will send your returned check to the district attorney

    Please Initial:
    RECORD REQUEST
    We will be able to provide better care for your pet if we are able to access their previous medical records. By signing below you are giving Custer McDermott Animal Hospital authorization to contact your pet's previous veterinarian and request a copy of their records. These records will be used for medical purposes only and will not be shared with any outside sources.