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New Client Form Test This is a test form to see if this works better for printing. Your Name(Required) First Last Cell Phone Number(Required)Additional name you would like on your accountAdditional cell phone number you would like on your accountAddress(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email(Required) By adding your email, you can set up appointments and Rx refills onlinePlace of Employment(Required)Employment Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Work PhoneFees for all services are due at the time services are rendered. Personal checks are accepted with ID and when approved by Certegy. Visa, MasterCard, Discover, Care Credit, and cash are also acceptable forms of payment. We do not offer in-house payment plans, but you may inquire about Care Credit, a no-interest financing option. We are also happy to provide printed estimates upon request of diagnosis.How did you hear about us?(Required) Referred by a friend Google Social media Drove by Other Who can we thank for the referal?I grant permission to Woodland Veterinary Hospital, its representatives, and employees the right to take pictures of my pet(s) to use for marketing and promotional purposes. I authorize Woodland Veterinary Hospital to copyright, use, and publish these photographs in both print and/or electronically. I agree that Woodland Veterinary Hospital may use such photographs of my pets with or without a first name and last initial (i.e.: Fluffy R.) for any lawful purpose including for example such purposes as social media content, publicity, illustration, advertising, and website content.(Required) I grant permission I DO NOT grant permission Owner Signature(Required)Date(Required) MM slash DD slash YYYY
This is a test form to see if this works better for printing.
Fees for all services are due at the time services are rendered. Personal checks are accepted with ID and when approved by Certegy. Visa, MasterCard, Discover, Care Credit, and cash are also acceptable forms of payment. We do not offer in-house payment plans, but you may inquire about Care Credit, a no-interest financing option. We are also happy to provide printed estimates upon request of diagnosis.
