Step 1 of 2 50% Thank you for the opportunity to care for your pet(s). Please fill out the following information so we can become better acquaintedInformationName*Date* Date Format: MM slash DD slash YYYY Address* Street Address City Zip State / Province / Region County Primary Phone*Cell PhoneEmail* Date Of Birth* Date Format: MM slash DD slash YYYY Driver's License #Preferred method of contact Primary Phone Cell Phone Text Message Email Spouse/Second Owner's Name First Last Spouse/Second Owner's Phone NumberAsk about our new Loyalty Program and our new App. On Apple Store or Googleplay search for “Waterloo Vet” and download our app to get your first loyalty stamp. Be sure to use the same email address we have on file for you*May we use your pet/s photos on FB, Instagram, our LED Sign or App? YesNoHow did you become aware of our clinic?Drive by signPrevious / Current ClientWebpageGoogle Search / InternetPersonal RecommendationWho Recommended Us?If you refer someone to us and they use your name on this Welcome Sheet, you will receive $10.00 off your next visit and they will receive $10.00 off their first visitPayment Policy: FULL PAYMENT IS EXPECTED UPON RENDERING OF SERVICESAlternate payment plans must be discussed prior to the start of treatment. Deposits are required on major/surgical cases, trauma cases and emergency work where hospitalization is required. We accept Visa, Master Card, Discover, American Express and Care Credit cards. You may apply for Care Credit with us at the time of service and approval or denial is immediate. We also accept cash and personal checks. There is a fee for all returned checks. To prevent the spread of infectious disease and parasites all in-patients, and out-patients, boarders and grooming pets must be current on all vaccines and be free of parasites. I understand this to be the strict policy of the clinic and authorize the doctors to provide my pet or pets with vaccinations and parasite control as needed and am responsible for the appropriate feesSignature*Date* Date Format: MM slash DD slash YYYY Patient InformationPatient #1Speices*DogCatHorsePet Name*BreedColorSexMFSpayed / NeuteredYesNoMicro-chippedYesNoDate of Birth / AgeKnown Medical ConditionsPatient #2SpeicesDogCatHorsePet NameBreedColorSexMFSpayed / NeuteredYesNoMicro-chippedYesNoDate of Birth / AgeKnown Medical ConditionsPatient #3SpeicesDogCatHorsePet NameBreedColorSexMFSpayed / NeuteredYesNoMicro-chippedYesNoDate of Birth / AgeKnown Medical ConditionsCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.