Client Form

Please complete this form to help us get to know you and your pet better.

Welcome to Manlius Veterinary Hospital

This form collects essential information about you and your pet to ensure we can provide personalized, effective care from the very first visit. Your details help us keep our records accurate and up to date.

Complete Our Form

Name *

First

Last

us? Address Hospital?

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Primary Phone *

Secondary Phone

Do you agree to receive text messages from Manlius Veterinary Hospital? *

I agree

By checking this box, you consent to receive informational and/or promotional text messages from Manlius Veterinary Hospital at the number provided, including messages sent by the autodialer. Consent is not a condition of purchase. Message & data rates may apply. Message frequency varies. Unsubscribe at any time by replying STOP. Reply HELP for help. Privacy Policy.

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

First

Last

Phone

Best Way to Contact You

At what time & what phone number is best to contact you about your pet? Who should we ask for?

Time *

Phone *

Who should we ask for? *

ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED

At your request, we will gladly provide a written estimate for fees and services. A deposit may be required prior to treatment, depending on the estimate. We gladly accept all major credit cards, cash, and offer CareCredit. We DO NOT bill in-house for any reason.

Please indicate if you would like more information about Care Credit *

To prevent the spread of infectious diseases, ALL hospitalized and boarded patients must be current on all vaccinations and free of internal and external parasites. The signature below authorizes this level of preventative care. The charges for this care will be added to the invoice upon discharge and are the sole responsibility of the pet's owner.

Signature *

Clear Signature

Today's Date *

How/why did you select us? *

If your pets travel or have travels outside this area, where?* *

Client Form

Welcome to Manlius Veterinary Hospital

Complete Our Form

Best Way to Contact You

ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED

We’re Here When You Need Us

Get in Touch

Address

Contact Us

Hours