Form

New Client Form

Save time during your next appointment! Complete your required forms online from any device at any time before your visit.
Get Started

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

MM slash DD slash YYYY
Name(Required)
Address(Required)
Sex(Required)
Max. file size: 50 MB.
Secondary Caregiver's Name
Would you like this secondary caregiver's E-mail to be CC'd on communications?
I understand that the Doctors and staff of the Williamsburg Veterinary Clinic are dedicated to providing me and my pet/s with the best diagnostic/ therapeutic and preventive care. The Williamsburg Veterinary Clinic works diligently to provide appointment times with as little wait time as possible. Estimates for services to be performed are available upon request. I acknowledge that the hospital's attempt to provide accurate estimates will, at times, require adjustment due to unforeseen factors or events. I accept full responsibility for fees that go beyond the original estimate, should I not be found to be available for consent.(Required)
The Williamsburg Veterinary Clinic loves making pets Facebook Famous and Instagram stars! Please give us your permission to share your pet(s) image and story on social media, our website, and other marketing materials. Your personal information will never be shared.(Required)
I understand that payment is required in full at the time of service, and I may pay with credit, debit, CareCredit, or cash. Should I fail to inform the office with reasonable notice that I will not make my appointment, Williamsburg Veterinary Clinic maintains the right to charge a fee to my account of $114.48 Finally, I understand that only I am in a position to authorize care of my pet/s. I will not send minors or third parties as my agent. I will list below the responsible parties (co-owners) of the pet/s on my account.(Required)
If by word of mouth or friend, please write their name.
Max. file size: 50 MB.
Clear Signature
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.
Share This