Forms - Mountain Vale Veterinary Clinic

PLEASE ONLY FILL OUT THESE FORMS IF YOU HAVE CALLED TO SET AN APPOINTMENT OR HAVE CALLED TO ADD A NEW PET TO AN EXISITING PROFILE

New Client Form

FIRST NAME

LAST NAME

PRIMARY PHONE NUMBER

SECONDARY PHONE NUMBER (optional)

E-MAIL

MAILING ADDRESS

CITY

STATE

ZIP CODE

I authorize treatment, surgery and any other procedure necessary during the course of my pet's illness. If I feel necessary, I will request a written estimate prior to and during the treatment of my pet's illness. I understand that financial responsibility for all charges incurred are mine. I also understand that all professional fees are to be paid at the time services are rendered. If this account is assigned to an outside agency for collections. I/we agree to pay all attorney's fees, court costs, process service fees, filing fees, and any charges or commissions, up to 35%, that may be assessed by any collection agency retained to pursue this matter with or without suit.

Yes

I understand the risks associated with restraining my pet during procedures. I have been given the opportunity to have any questions answered regarding this risk. I also understand that if I CHOOSE TO restrain my animal, I may cause injury to myself and this may delay treatment of my pet. I assume any responsibility for my own injury and hold Salt Lake Veterinary Services and its staff free of any liability.

Yes

I understand there are risks and side effects associated with administering vaccines. I have been given the opportunity to have my questions answered regarding these risks and side effects. I choose to continue vaccinating my animals because the risks and side effects are minimal compared to the illnesses we are trying to prevent.

Yes

I agree that by selecting "yes" in the boxes above that I am agreeing to the terms and conditions associated with each.

Pet Info Form

Additional Pet Info Form

If you have more than two pets you need to submit forms for, please refresh the page to fill out the additional forms.

(You are not required to fill out the client form if you have already filled it out once)

For more information, or to schedule an appointment for your pet(s), call us at 801-261-3655 .

New Client Form

Pet Info Form

Additional Pet Info Form

Contact Information

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