Existing Client / New Patient Form

Please use this form only if you are an existing client of Metro Cat Clinic and are adding a new cat/kitten to your family.

If you are not an existing client, please use the New Client/Patient Form.

Owner's Name

Primary Phone

Address

City

Zip

YOUR CAT'S INFORMATION

Name of Cat

Birthdate of Cat or Age

Sex

Male Female

Is Cat Spayed or Neutered?

Yes No

Is Cat Declawed?

Yes No

Color

Domestic Short Hair Domestic Medium Hair Domestic Long Hair

Purebreed

Date of Last Vaccine

A $30.00 fee will be charged on all checks returned for non-sufficient funds.

I hereby authorize the veterinarian to examine, prescribe for, or treat my cat(s).I We), the undersigned, hereby agree to pay all amounts and charges hereafter incurred by by members of my (our) family for services rendered by this office. Failure to make payment when requested is basis for legal action, and the undersigned agrees to pay all costs of collection, including a reasonable fee, and hereby waives the rights of exemption under the laws of the state of Alabama.

Signature of Owner

Signature of Co-owner

Method(s) of Payment*

Cash Check Debit Card MasterCard VISA Discover CareCredit