We are open with normal business hours and operating with curbside check-ins/outs and curbside delivery of foods & medications.
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New Client and Pet Information Form
Media Consent Form
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Pharmacy
Contact Us
Home
About Us
-Meet the Team
-Meet the Doctors
Blog
Services
-Wellness Care
-Full Service Diagnostics
-Dental Care
-Senior Pet Care
-Vaccinations
-Surgery
-Spay and Neuter
-Nutritional Counseling
-Microchipping
-Laser Therapy
-Behavioral Counseling
-International Travel and Health Certificates
Resources
-New Client and Pet Information Form
-Media Consent Form
-Payment Options
Blog
Pharmacy
Contact Us
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503-968-2911
New Client and Pet Information Form
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New Client and Pet Information Form
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Primary Phone
*
Secondary Phone
*
Primary Phone Type
*
Home
Work
Cell
Secondary Phone Type
*
Home
Work
Cell
May we contact you via text message (SMS)?
*
Yes
No
May we contact you at work?
*
Yes
No
Email:
*
What is your preferred way of being contacted?
Phone
Text Message
Email
Is there someone else who is authorized to make decisions for your pet?
*
Yes
No
Name
*
First
Last
Their Home Phone:
*
Their Cell/Work Phone:
Pet Information
Pet’s Name
Breed
Date Born
MM slash DD slash YYYY
Species
*
Dog
Cat
Other
Sex
*
Male
Female
Has your pet been spayed / neutered?
*
Yes
No
Colors & Identifying Markings
*
Does your pet have a microchip identification?
*
Yes
No
In the last 12 months, has your Pet had:
A complete physical examination?
*
Yes
No
Regular vaccinations?
*
Yes
No
Do you have health insurance for your Pet?
*
Yes
No
Willowbrook Veterinary Hospital advocates the use of pet health insurance. We can assist you with preparing, filing, and sending claim forms in order to expedite your reimbursement.
FINANCIAL POLICY: Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your pet until you have confirmed your desire to do so by 1) signing the client consent and estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your pet. We accept cash, Visa, Mastercard, American Express, Discover, and CareCredit payments. We do not accept checks unless prior arrangements are made with the hospital manager and/or owner. There is a $50 fee for checks that are drawn against an account with insufficient funds. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. If you check the following space, this will indicate that you have read and accepted our financial policy:
*
I agree on all terms stated on this form.
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