Welcome to the Family! Name * First Name Last Name Spouse/Other First Name Last Name Are you active duty, retired or military veteran? Yes No Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Primary Phone * (###) ### #### Cell Phone * (###) ### #### What is you preferred method of payment? Cash Check Credit/Debit Care Credit/Other How did you hear about us? If you were referred by someone please let us know! * (1) Patient Name Species Canine Feline Breed Age/DOB Sex * Male Neutered Male Female Spayed Female (2) Patient Name Species Canine Feline Breed Age Sex * Male Neutered Male Female Spayed Female (3) Patient Name Species Canine Feline Breed Age Sex * Male Neutered Male Female Spayed Female Social Media Consent I grant Wateree Animal Hospital, its representatives and employees the right to take photographs of me and/or my pet(s), and to copyright, use and publish the electronically to social media accounts and/or Wateree Animal Hospital's website. I agree that Wateree Animal Hospital may use such photographs of me and/or my pet(s) without my name for any lawful purpose, including, for example, such purpose as publicity, illustration, advertising, and Web content. The above may take photos of me and/or my pet(s) The above may NOT take photos of me and/or my pet(s) Electronic Signature of Responsible Agent * Wateree Animal Hospital will gladly prepare a written estimate before services are rendered. This will be important to you since ALL PREFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. In case of extensive medical or surgical procedures, when full payment may be difficult at discharge, we do VISA, Mastercard, Discover, or Care Credit. By signing below as the owner or agent, I confirm I am at least 18 years of age and have read and understand the preceding acknowledgement. Thank you for submitting your form with our Elgin Office! If you have any questions please give us a ring at (803) 438-7667. New Client Form Tell us about your pet(s)!
