New Patient Form in Port Hadlock, WA | Hadlock Veterinary Clinic

Name*
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Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
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How would you prefer to receive reminders?
- Email
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May we call you at work?
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How did you find out about our clinic?
Clinic for Pet Records Request:
Please Read Important Billing Information:

In order to control the cost of billing, we ask that the bill for services is paid at the time services are rendered unless other arrangements are made in advance. The undersigned agrees to be ultimately responsible for any bill incurred in this office. Accounts 30 days old will incur interest and finance charges at the rate of 12% per annum. Accounts 90 days old will be sent to a collection agency. There will be a service charge of $50.00 on all returned checks.

By signing below, I authorize the doctor to administer treatment as agreed upon.
Signature*
Date*
Date Format: MM slash DD slash YYYY
*Please bring a valid form of identification to your first appointment to be kept on file for billing purposes.
Media Release
I authorize Hadlock Veterinary Clinic and its representatives to take photographs and other documentation of my pet(s) for educational and promotional purposes. All images, documents, videos, and other media will be altered to omit names and other identifying marks as to maintain confidentiality. I hereby grant consent for use of these documents without compensation and release Hadlock Veterinary Clinic from any and all claims arising from the use of these documents.*
- Yes
- No
Signature*
Date*
Date Format: MM slash DD slash YYYY
Pet Information
Pet
Name Species Breed Color Age Sex Spayed / Neutered? Permanent ID#

Click the "+" symbol to add additional pets
Email
This field is for validation purposes and should be left unchanged.

New Patient Form

Media Release

Pet Information

Testimonials

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After Hours Emergency Care

Name	Species	Breed	Color	Age	Sex	Spayed / Neutered?	Permanent ID#