Client & Patient Update Form

Name: Fohey Veterinary Hospital
Address: 824 S Mill St., Clio, MI, 48420, United States
Telephone: 810-686-1110
Price range: $

Welcome back to our hospital!

Complete your form online!

Welcome back to our clinic and thank you for choosing Fohey Veterinary Hospital for your pet’s care! Please complete the following information about you and your pet(s) accurately so we may update our records. Thank you!

About You

Name *

First

Last

Spouse/Co-Owner's Name

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Primary Phone *

Secondary Phone

Spouse/Co-Owner's Phone

Preferred Method of Contact *

Primary Phone
Secondary Phone
Email

Preferred Method of Contact for reminders *

Call
Email
Text
Mail

About Your Pet(s)

Pet's Name *

Species *

Dog
Cat
Other

If other, please specify *

Breed *

Color *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Age/Date of Birth *

Add another pet? *

Pet's Name *

Species *

Dog
Cat
Other

If other, please specify *

Breed *

Color *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Age/Date of Birth *

Add another pet? *

Pet's Name *

Species *

Dog
Cat
Other

If other, please specify *

Breed *

Color *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Age/Date of Birth *

Have your pets been seen by another clinic since their last visit with us? *

Clinic's Name *

Clinic's Phone *

Reason for Visit *

Cancelled Appointments & No Show Policy

I understand that there will be a $50.00 fee for appointments not canceled within 24 hours and no-show appointments, and a $75.00 fee for missed surgery appointments. *

I have read and understand

Payment Policy

Our office does not bill. Payment is due on the day of service. We will gladly prepare a written estimate if you desire. Please ask our doctor during your appointment. Occasionally, a deposit may be required for certain procedures. We accept the following forms of payment: cash, credit/debit (including CareCredit, Visa, Mastercard, Discover, and American Express. *

I have read and understand

Treatment/Payment Authorization

I understand every effort will be made to achieve a successful outcome, and provisions will be made for safe in-hospital care and handling. I certify that I am 18 years of age or older and assume responsibility for all charges incurred. I understand that charges are due at the time services are completed unless prior arrangements have been made. I agree that should my account become delinquent; I will be responsible for all collection costs, including but not limited to the outstanding balance, interest, attorney fees, court costs, and collection agency fees. *

I have read and understand

I hereby authorize Fohey Veterinary Hospital to treat my pet(s) and furthermore understand that unforeseeable adverse reactions to treatments are always possible and authorize treatment necessary should any reactions occur. *

Clear Signature

Please sign

Date *

Social Media Release

I grant permission for Fohey Veterinary Hospital to use photos of my pet for the purpose of social media posting (Facebook, Twitter, Youtube, and other sites). *

Use image only
Use image and my pet's first name
I do not grant permission

Signature *

Clear Signature

Date *

Have a question?

Use the form below and a member of our team will get back to you as quickly as possible. If you need immediate assistance, please call us directly at 810-686-1110.

Name *

First

Last

E-mail *

Phone

Comment or Message *

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