New Client Registration Form

Owner's Name

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Primary Phone Number*

Additional Phone Number

Work Phone Number

Email*

Enter Email Confirm Email

Veteran ID

GrandView Animal Care Center offers discounts to active and retired Veterans. Please attach a copy of your current ID here.

Co-owner's Name & Contact #

Name

First Last

Phone

Emergency Contact

Name

First Last

Phone

How did you find out about our practice?

Please name the person who referred you so we are able to thank them.

Pet Information

Name*

First

Species*

Breed (if known)

Gender

Color

Date of Birth or Age (if known)

Previous Veterinary Practice (if any)

If you have a digital file of your pet's record, please attach them here.

Is your pet on any medication or supplement?

Yes
No

If Yes, please list the medication or supplement

Does your pet have allergies or drug reactions?

Yes
No

If Yes, please list the allergies and reactions

Are there any current or past medical conditions of which we should be aware?

Yes
No

If Yes, please comment on the condition(s) and indicate if they are current or past conditions

Please use the following box to give us any other relevant information about your pet

I acknowledge that I have read and understand the terms listed within the Authorization Information.*

I hearby authorize Grandview ACC to examine, prescribe for or treat my pet. I assume responsibility for all charges incurred in the care of the above animals. An estimate describing treatment and cost will be provided to me upon my request. I also understand that these charges will be paid the the time services are rendered. We accept cash, personal check (with a valid Drivers License) American Express, Visa, Mastercard, Discover, and Care Credit. There is a $20 fee for all returned checks. If necessary, all fess associated with with any collections process (including, but not limited to: agency fees, attorney fees and court costs) will be the responsibility of the delinquent party. A 50% deposit is required for all hospitalization. There is a $25 fee any missed appointments or Same day cancelations. Grandview Animal Care Center reserves the right to share your pet's photograph (and/or brief story of progress/improvement - last name private) on our website and social media outlets.

Acknowledgement

Appointment Commitment*

Our goal is to provide quality care to our patients and clients and we take great pride in that reputation. Part of providing quality care is carefully scheduling healthy and sick pets into a time frame that allows our veterinarian to make the best choices for care. Missed appointments greatly change that dynamic. Failure to notify us that you are not appearing for the appointment time that has been reserved for you will result in the inability for us to reschedule that appointment. There is a $25 fee for any missed appointments and same day cancelations.

Acknowledgement

GrandView Updated Polices 2024*

Thank you for trusting your pet's medical care to GrandView Animal Care Center. When you schedule an appointment with our office we set aside enough time to provide you with the highest quality of care. Should you need to cancel or reschedule an appointment please contact our office as soon as possible and no later than 24 hours prior to your scheduled appointment time. This provides us the opportunity to schedule other patients who may be waiting for an appointment. As a courtesy we make reminder call for appointments along with email and text reminders.

Acknowledgement

Monday	8:00am – 8:00pm
Tuesday	9:00am – 5:00pm
Wednesday	Closed
Thursday	8:00am – 8:00pm
Friday	9:00am – 5:00pm
Saturday	Closed
Sunday	Closed

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New Client Registration Form