New Client Form

Save time during your next appointment! Complete your required new client form online from any device at any time before your visit.

New Client Form

Client Information

Pet's Information

Vaccination History

Please indicate the month/year your pet received the following vaccinations:

Pet's Medical History

Payment Information


We will ask that you provide a current Driver’s License number and a current phone number for check writing privileges. Please provide that information on your check.

I hereby authorize the veterinarian to examine, prescribe for, or treat the above-described pet. I am 18 years of age or older and am the legal/authorized agent for this animal. I assume responsibility for all charges incurred on the care of this animal, understanding that all professional fees are to be paid in full at the time service is rendered. County Line/Heritage Animal Hospitals do not offer billing plans, and any unpaid balances are subject to service charges after 30 days. If payment is not received within 30 days, account is subject to be sent to a collection agency. I understand that I will be responsible for collection fees of 33 1/3% in addition to billing fees. Estimates will be provided for treatment/surgical procedures, and a deposit of 50% of estimated total is required prior to admission for treatment/surgery. Your signature below is acknowledgment and acceptance of these terms.