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Client Information Intake Form

Balsam Animal Hospital Client Form

Thank you for giving us the opportunity to care for your pet(s). So that we may become acquainted, please complete the following.
  • Patient Information

  • FULL PAYMENT IS REQUIRED AT TIME OF SERVICE. Deposits are required on major medical/surgical cases & emergencies that require hospitalization. We DO NOT carry open accounts, however, we accept all major credit cards & Care Credit. To prevent the spread of infectious diseases and parasites, surgical patients and hospitalized animals must be current on all vaccines and the pet must be free of internal and external parasites. I hereby authorize Balsam Animal Hospital to provide any vaccines and parasite control as needed. I understand and agree that I am financially responsible for any and all charges incurred while my pet is under the care of Balsam Animal Hospital.
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