New Client

"*" indicates required fields

Thank you for giving us the opportunity to care for your pet. Please help us to better meet your needs by taking a moment to complete this information.

Patient/Client Information


Owner's Birthday*

Only used when filling controlled drugs

Payment Method*

Reminder Method*

Appointment Reminders Only

Photo Release Form

I grant Mebane Pet Clinic, its representatives, and employees the right to take photographs of me and my pet(s). I authorize Mebane Pet Clinic, its assigns, and transferees to copyright, use and publish the same in print as well as electronically.

I agree that Mebane Pet Clinic may use these photographs of me and/or my pet(s) with or without my name for any lawful purpose, including use on Facebook, on the Mebane Pet Clinic website, in AVI Mark, and in our clinic.

I have read and understand the above.

MM slash DD slash YYYY

Reset signature Signature locked. Reset to sign again

This field is for validation purposes and should be left unchanged.

Other Forms

Hospital Admission Form

Blood Glucose Curve

Surgery Consent Form

Dental Consent Form

Change Address