New Client Form

Save time during your new client appointment. Complete your required form online from any device at any time before your visit.

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New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet before your visit.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Do you have a second pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Do you have a third pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Do you have a fourth pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Do you have a fifth pet? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

What is the microchip number?

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your Pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your Pet. We accept cash, credit, carecredit and check payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

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Download Our App and Connect with Us on PetDesk

At Animal Care Clinic, we take veterinary medicine to the next level. We proudly serve the pets of Laporte, Blackduck, Solway, Cass Lake, Turtle River, Becida, Walker, and the surrounding areas. Request an appointment for your pet using our online system on PetDesk, and keep up with your pet’s health by downloading our app.

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Location

410 Clausen Ave. SW
Bemidji, MN 56601

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Contact Information

P: 218-444-2222
E: info@animalcarebemidji.com

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Hours

Mon-Fri: 7:30am – 6:00pm
Sat: 8:00am – 12:00pm
Sun: Closed

Questions?

Get in touch! Please complete the form below, and a member of our team will get back to you as quickly as possible.

Name *

First

Last

Email *

Phone

How can we help you? *

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