Client / Patient Form

Thank you for giving us the opportunity to care for your cat. We are always happy to answer questions about your cat’s health.

Please fill out a separate form for each cat / kitten.

Are you a current Metro Cat client?

Yes No

Owner's Name

Spouse / Other

Address

City

State

ZIP

Primary Phone

Secondary Phone

Spouse / Other Phone

How Did You Learn of Metro Cat Clinic?

YOUR CAT'S INFORMATION

Name of Cat

Birthdate of Cat or Age

Color

Sex

Male Female

Is Cat Spayed or Neutered?

Yes No

Is Cat Declawed?

Yes No

Microchipped?

Yes No

Domestic Short Hair Domestic Medium Hair Domestic Long Hair

Purebreed

If new client, your previous Veterinarian and date last seen

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