Client Information Form

UPDATE June 2026

We are not accepting new clients to our practice at this time.

This form remains available for existing clients to confirm their contact information.

Owner Information

First & Middle Initial

Last

Address

City

State

Zip Code

Home Phone

Work Phone

Cell Phone

By providing my phone number, I consent to receive SMS text messages from Cats Exclusive for appointment reminders, marketing messages, and general two-way communication. Msg frequency varies. Msg data rates may apply. Reply HELP for support. Reply STOP to opt out. Refer to our privacy policy and terms and conditions for more information.

I Consent to receive SMS text messages
I Do Not Consent to receive SMS text messages

Email Address

Preferred

Employer

Position

Spouse or Partner

First & Middle Initial

Last

Employer

Position

Work Phone

Emergency Contact

Name

Relationship

Phone

Cat(s)

Please include a list of your cat's names:

How Did You Find Us?

Other

Whom may we thank for referring you to us?

Optional: If applies, reason for changing veterinarian

Financial Policy:
I hereby authorize the veterinarian to examine, treat, and prescribe for the above-described animal(s). I assume all responsibility for all charges incurred in the care of this animal. I understand that payment is due at time services are rendered and that there may be a deposit required for any hospitalized treatment. Acceptable forms of payment are cash, checks (up to the amount of $300.00), debit and credit cards (Mastercard/Visa/Discover) and Care Credit.

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