Cozy Cats Veterinary - A Cat Practice New Client Information Name(Required) First Last Co-owner Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Preferred method of contact(Required)EmailTextCell PhoneHome PhoneWork PhoneEmail(Required) Co-owner email Cell Phone NumberCo-Owner Cell Phone NumberHome Phone NumberWork Phone NumberOccupation How did you learn about our practice? What practices have you brought your cat(s) to previously? Emergency contact Do you have pet insurance Yes No Cat information (Please list all cats living in your home)Cat's Name Sex Male Female Spayed / Neutered Yes No Breed Color Indoor Only Yes No Birthdate MM slash DD slash YYYY Declawed Yes No How Long Owned Any additional information we should know about your cats?We will gladly prepare a written estimate of service is you desire (please ask our doctor or technician). All professional fees are due at the time of service. There will be a $40 service charge for any check returned. All new clients will be asked to pay a $125 new client fee ($40 processing fee and a $85 new client exam hold fee). You will be asked to provide a credit card to be stored on your file to cover any charges accrued for your pet. Your signature below authorizes Cozy Cats Veterinary LLC - A Cat Practice to run your stored card for any charges accrued on your account. Signature
