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Advanced Veterinary Medical Center

408-956-8061

New Client Form

Call Now 408-956-8061

New Client Form

New Client Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

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  • Pet Information

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  • I, the owner of the above named animal(s), understand and agree that the account balance is due in full upon receipt of services at Advanced Veterinary Medical Center.

    EMERGENCY SERVICES: A DEPOSIT WILL BE REQUIRED BEFORE WE WILL BEGIN A TREATMENT PLAN.

    Payment methods accepted: Cash, Personal Check (Established clients only), Visa, Mastercard, Discover, or Debit Card. YOU AGREE TO REIMBURSE US THE COLLECTION FEES OF ANY COLLECTION AGENCY, WHICH SHALL BE BASED ON A PERCENTAGE AT A MAXIMUM RATE OF 33 1/3% OF THE AMOUNT DUE AT THE TIME YOUR ACCOUNT IS PLACED WITH A COLLECTION AGENCY, AND ALL COSTS AND EXPENSES INCURRED FOR ANY COLLECTION EFFORTS ON YOUR ACCOUNT, INCLUDING REASONABLE ATTORNEY’S FEES INCURRED BY THE COLLECTION AGENCY. THIS CONTRACT SHALL COVER ALL MEDICAL TREATMENT AND SERVICES UNTIL REVOKED BY EITHER PARTY IN WRITING.

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