New Client Form

25%

Owner Info

Client Name*

First*

Middle

Last*

Spouse/Partner Name:

First*

Middle

Last*

Phone*

Email address*

Mailing Address:

Street Address*

Address 2

State*

Zip*

Physical Address

My physical address is different than my mailing address.

Physical Address:

Street Address*

Address 2

State*

Zip*

Employer

Select "Next" for Pet Info

Appointment Policy:

I understand that I will be charged a $33 non-cancellation fee for any appointment that I have scheduled for which I do not show or call 24 hours in advance of the appointment time to cancel. Failure to pay this fee will be treated the same as any other unpaid balance on my account which is subject to interest and collections.

Initials*

Boarding Reservation Policy:

I understand that I will be charged a fee of half the cost of my pets scheduled boarding as non-cancellation fee for any reservation that I have scheduled for which I do not show or call 48 hours in advance of the appointment time to cancel. Failure to pay this fee will be treated the same as any other unpaid balance on my account which is subject to interest and collections.

Initials*

Waiver and Release for Use of Photographs*

I give permission for the staff of Copper Ridge Animal Hospital to take photographs of my pet and use the photographs in non-profit promotional activities; such as the hospital’s website and social networking sites (Facebook). Any photographs taken will become property of CRAH. Owners’ names will not be used in any photograph captions.

Yes - I give permission

No - I do not give permission

Electronic Signature - Please Print*

By printing your name on this form it acts as your signature and you agree the above policies.

Date*

VETERINARY DISCLOSURE FORM*

I understand that Copper Ridge Animal Hospital is not staffed twenty-four (24) hours a day and after hour treatment of patients is at the discretion of the veterinarian. Business and medical staffing hours are:
Monday-Friday 7:00 AM-5:30 PM
Saturday 8:00 AM-10 AM-BOARDING ONLY
Sunday/Holidays Closed
We have no in-house, on-duty continuous medical staff care at these times:
1. Overnight from 5:30 PM-7 AM Monday-Friday
2. Weekends from Friday 5:30 PM to Monday 7 AM
3. Holidays

Emergencies are handled by the Shenandoah Valley Regional Veterinary Emergency Clinic in Verona. The telephone number is 540-248-1051. The hours are from 6 PM to 8 AM Mon-Thurs and 6 PM Friday thru 8 AM Monday.
Please call ahead.

I agree

Electronic Signature - Please Print*

By printing your name on this form it acts as your signature and you agree the Veterinary Disclosure Form.

Date*

Comments

How did you learn about our practice?*

Are you human?*

This field should be left blank

New Client Form:

Owner Info

Pet Information 1

Pet Information 2

Pet Information 3

Pet Information 4

Appointment Policy:

Boarding Reservation Policy:

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