Whitefish Animal Hospital

713 E 13th St
Whitefish, MT 59937

(406)862-3178

www.whitefishanimalhospital.com

New Clients Form

Please provide the date and time of your scheduled appointment :
Client Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Patient Information (required)

Check here if you would like your pet's history transferred to our hospital.
Check here if we have permission to release your pet's medical records to a veterinary specialist, kennel, or animal adoption agency if needed.
Financial Agreement
Full payment is required at the time services are provided. A deposit is required to begin hospitalization or emergency treatment of your pet. We will provide an estimate of current and anticipated charges anytime upon your request. We accept cash, check, all major credit cards, and our third party payment plan (upon approval).
By checking here I confirm that I have read and understand the financial agreement and agree to these terms. I request that veterinary care be provided for pets presented by me or my agents and assume financial responsibility for services rendered.

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