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New Client Form

Rustic Line

Welcome, New Clients!

Help us get to know you and your pet before your first visit by filling out our New Client Form.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Pet Owner Information

Owner:*
Address:*

Contact:*

Employment:

Spouse/Co-Owner

Name:

Pet Information

Referral Information

Put 'n/a' if none.

Payment Policy

Riverside Veterinary Clinic fees, like those of human hospitals, reflect the quality of health care that our doctors and staff provide your pets. Riverside uses the best equipment, the safest drugs and vaccines, and we have a highly motivated hospital team to ensure the health and safety of your pets. Our payment policy requires payment in full at the end of your appointment. If your animal is dropped off for the day or hospitalized overnight, you will receive a cost estimation at the time of the drop-off. This preliminary estimate is based on the medical tests and treatments recommended by the doctor based on your pets age, medical history, and symptoms. Our payment policy requires payment of the cost estimate at the time of drop off for care. If additional medical care is required, the doctor will call and discuss it with you prior to providing additional treatment or medicine. If more care or testing is requires beyond the initial estimate, additional payment must be made before care is given. Riverside Veterinary Clinic cannot provide care to your animal without the payment. If checks are returned to Riverside for Not-Sufficient Funds (NSF,) the client will incur a charge of $50 to their account. Payment with cash or Credit Card is required to settle the account. If you have an outstanding bill, we cannot provide additional services until the past-due balance is paid in full. All outstanding bills will incur a 2% interest and $3.50 bill fee monthly. Should Riverside Veterinary Clinic have to send the bill to collection, a $35 fee will be added to the bill. Payment options include: Cash, Check, Visa, Master Card, Care Credit.