Name Required
Address Required
DayTime Phone Required
Phone Type
Evening Phone Required
Phone Type
Pet Information Required
Breed
Are your pets vaccines current?
Do you have pets medical records?
Medical records at another veterinary practice?
May we request a transfer of records?

Please Read:

I understand, by indicating I agree and submitting this registration, which I am responsible for any charges incurred by my pet while in the care of the doctors at Veterinary Village, LLC and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Veterinary Village, LLC's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.

I have read this statement and