Name *

First

Last

Primary Phone *

Secondary Phone

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

How would you prefer to be contacted? *

Is there a spouse/partner/family member who should be listed on your account? *

Yes
No

Spouse/Partner/Family Member Name *

First

Last

Relationship *

Spouse/Partner/ Family Member Contact Number *

Emergency Contact Name *

First

Last

Relationship *

Emergency Contact Phone *

How did you hear about us? *

If other, please specify *

Whom may we thank for the referral? *

Pet's Name *

Upload a photo of your pet

Click or drag a file to this area to upload.

Species *

If other, please specify *

Age/Date of Birth *

Breed *

Color *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Is your pet microchipped? *

Yes
No
Not sure

Microchip Number *

Do you have pet insurance? *

Yes
No
No, but I would like more information

Reason for visit *

Do you have a confirmed appointment? *

Yes
No

Appointment Date & Time *

Date

Time

Important medical history for your pet's visit *

Has your pet ever seen a veterinarian before? *

Yes
No

Does your pet need a refill on medication(s) or flea/tick/heartworm preventatives today? *

Yes - fill here
Yes - through our online pharmacy
Yes - fill through outside pharmacy
No

What medications do you need refilled today (please include medication name, strength, dosage, and frequency)? *

Upload records from shelter/breeder/veterinarian

Click or drag files to this area to upload. You can upload up to 10 files.

Client Policies & Procedures

We love social media! Do we have your permission to post pictures of your pet(s), you and your pet(s), and/or your pet(s) and our team on Facebook, Instagram, website, and any other marketing and/or other social media outlets we may choose to use? *

Yes
No

I agree to release Sumner Veterinary Hospital and 24-Hour Emergency from all claims for libel, slander, invasion of privacy, infringement and copyright, right of publicity, or any other claim and confirm that I am over the age of 18 years old. *

I have read and agreed

Our office accepts Visa, Mastercard, Discover, and American Express. We also accept cash and checks (only with verification of valid driver's license or other ID at the time of payment).

In addition, we also offer several third-party financing options for our clients via CareCredit and Scratchpay. We accept a variety of CareCredit plans based on the total transaction amount for your pet. CareCredit requires that payment only be made for services as they are rendered; we cannot charge services to your account in advance. Additionally, the use of CareCredit requires that the card be present every time and that two forms of identification are verified. We appreciate your understanding of our desire to protect your account/identity.

As financing options are offered, we cannot offer additional in-house payment plans for our services. Clients needing additional financial support are encouraged to apply for CareCredit or ScratchPay with a co-signer.

Full payment is due at the time of service. This includes any charges/fees agreed to by my authorized proxy. Our team is happy to provide any client with a written treatment plan prior to services being rendered. The client will be responsible for a 1.5% monthly finance charge on accounts over 30 days and any collection and/or legal fees on accounts over 90 days. Your signature below indicates your agreement with these policies.

Signature *

Clear Signature

Date *

New Client Form

Thank you for choosing Sumner Veterinary Hospital!

Client Policies & Procedures

24/7 Veterinary Care in Sumner, WA

No Show & Cancellation Policy

Contact Info

Address

Contact

Hours

Lodging Hours

Grooming Hours

SVH Camp K9 Hours

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