Katoomba Veterinary Clinic

59 Waratah street
Katoomba, NSW 2780

(024)782-3273

katoombavets.com

New Client Check In

 

If you would like to make an appointment, you can assist us to expedite your check in by submitting this form.

 

New Client

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Mobile Phone
Phone TypePhone Number
E-Mail Address (required) :
Pet's Name (required)

Age: Years, Months (required)

Sex: (required)
Male
Female
Unknown


Type of Pet (required) :
Breed:

Desexed? (required)
Yes
No


Does your pet have previous medical records?
Are your pets vaccines current?
Medical records at another veterinary Practice? (please add their details) (required)
Yes
No


Name of Former Veterinary Practice and contact number

Reasons or conditions that prompted your visit?

Please list any additional pets here

How did you hear about us
Search engine
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True local
Start local
Verbal
facebook
Other


Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Katoomba Veterinary Clinic 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 Katoomba Veterinary Clinic'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 -
I Agree
I Disagree



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