New Client Form

"*" indicates required fields

NOTE: Please call our office before submitting this form to verify that we are accepting new clients.


MM slash DD slash YYYY

Address*















Do you approve of Goldsmith Veterinary Clinic posting photos of your pet on social media?*


Pet Health History

If Known

Sex*


Neutered/Spayed*


Microchipped*


I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the case of the animal. I also understand that all professional fees are due at the time services are rendered and that a $3.00 billing fee will be charged monthly for all accounts that are more than 30 days past due. *Please note that we do not accept checks from first time clients. Please use cash, or a credit or debit card for payment. Thank you for understanding.*

Authorization*

Cancelation Policy: I understand that after three instances of having missed an appointment or canceling an appointment within two hours of the scheduled appointment time, I will be charged the cost of an exam.

Cancelation Policy*

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







Meet the Doctors

Our Services

Rx Refill

What's Next

  • 1

    Call Us to Make an Appointment

  • 2

    Meet With a Doctor for an Initial Exam

  • 3

    Put a Plan Together for Your Pet

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