Paws 'N Claws Veterinary Clinic

225 N. Lemay Ave., #2
Fort Collins, CO 80524

(970)493-6696

pncvets.com

New Client Check In

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form. Please contact your previous veterinary clinic and have them e-mail your pet's medical records to info@pncvets.com. Thank you.

New Client

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address :
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed: (required)

Sex: (required)
Male
Female


Is your pet neutered/spayed? (required)
Yes
No


Are your pets vaccines current?
Yes
No


Do you have your pets medical records?
Yes
No


Name and Phone Number of former Veterinary Practice.

Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here and the reason for their visit.

I would like a confirmation call for my appointment.
Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Paws 'N Claws Veterinary Clinic and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Paws 'N Claws Veterinary Clinic's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.
I have read this statement and - (required)
I Agree
I Disagree



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