New Client Form

Payment is due at time of service. Cash, check, and credit card are accepted forms of payment. All returned checks are subject to a $27.50 NSF fee. I understand City Way Animal Clinics will utilize the Marion County Bad Check Program to prosecute bad check writers to the fullest extent of the law.*
- I assume responsibility for all charges incurred in the care of my pet(s).
Today's Date*
Date Format: MM slash DD slash YYYY
Name
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Client Information