New Client Form

    Kingstowne Cat Clinic, LLC

    I hereby give my permission to the business entity known as the Kingstowne Cat Clinic to:

    1. Maintain my personal information for purposes of maintaining a record of myself and my pets.
    2. Transmit my pet or pet’s medical record to the facility of my choice, should I so request it.
    3. Furthermore, I understand that payment is due at time of services rendered. I understand that the Kingstowne Cat Clinic is unable to serve as a creditor and cannot extend credit for services rendered.

    Please be advised: Kingstowne Cat Clinic does not have in-house care, 24 hour medical staff outside of normal business hours which are as follows:
    Monday: 8am-7pm
    Tuesday: 8am-6pm
    Wednesday: 8am-6pm
    Thursday: 8am-7pm
    Friday: 8am-6pm

    In the event of an overnight surgery or boarding, a staff member will be here to check on/provide food and any medications twice daily.


    Owner Information

    Owner's Name:

    Address:

    City:

    State:

    Zip:

    Email:

    Home Phone:

    Cell Phone:

    How do you prefer we contact you?:


    First Kitty

    Name:

    Breed:

    DOB:

    Sex:

    Color:

    Microchip #:


    Second Kitty

    Name:

    Breed:

    DOB:

    Sex:

    Color:

    Microchip #:

    Upload Records: