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Call us at 916-791-1111
3970 Douglas Blvd.
Roseville, CA 95661
Please fill out the form below to register as a new client, or download the form and return it to our office.
First Name (required)
Last Name (required)
Day Time Phone
Your Email (required)
Pet's Age: Years, Months
Are your pets vaccines current?
Do you have pets medical records?
Medical records at another veterinary Practice?
Name of Former Veterinary Practice
May we request a transfer of records?
Would you like us to call you for your appointment?
Reasons or conditions that prompted your visit?
Special requests or conditions?
Please list any additional pets here
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Douglas Blvd Veterinary Clinic and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Douglas Blvd Veterinary Clinic's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.
I have read this statement and -
I AgreeI Disagree