New Patient Form

Client Information

Patient Information

If yes, please bring the certification(s) to your pet’s appointment. If no, please provide your pet’s previous veterinary hospital contact information.

Payment Authorization

I certify I am the owner of this pet, the above information is accurate, and hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. Payment must be rendered at time of service. We accept cash and all major credit cards including Care Credit. Personal Checks are welcome when accompanied by a driver’s license. The entire balance of all credit accounts is due and payable in accordance with the terms as stated on the invoice. The parties agree that all payments still owing after the due date may be assessed a service charge at the rate of .83% per month/10% per annum. In addition, in the event of default where it becomes necessary to place this account in the hands of a third party for collection, the undersigned agrees to pay all costs of collection, including reasonable attorney’s fees and court costs. If you have any questions regarding your payment, please discuss it with a client service representative before the start of your visit.

Thank you for choosing Cherry Hill Animal Hospital for your pet’s healthcare.