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


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

Pet Health History

If Known




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.*


New Client deposit: I understand that as a new client, I will be required to make a deposit of the cost of the initial exam. That deposit will be applied in full to the first appointment’s total cost. If the first appointment is missed or canceled within two hours of the appointment time, the deposit will be forfeited. The new client will then be required to make an additional deposit if a new initial exam is to be scheduled.

New Client Deposit Agreement*

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.

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