New Clients

At Mitchell Animal Clinic, you can expect an integrative approach to the medical care for your pet. We believe in nurturing the human-pet bond and creating a harmonious relationship between people and pets. We appreciate the role we get to play in your pets’ health care.

If you have any questions or comments about how we can care for your pet, please contact us today at (251) 338-2591.

Client Information:
Name

First Name

Middle Initial

Last Name
Driver's License*
Your Date of Birth*

MM slash DD slash YYYY
Street Address

Street Address

City

State / Province / Region

ZIP / Postal Code
Email Address*
* We are a paper-light practice, using email regularly! Your email address will only be used within our
business and pharmacy services to send you reminders for your pets and information from the vet.
Primary Phone*

circle: cell / home / work
Secondary Phone*

circle: cell / home / work
Additional Contact:
Name

First Name

Last Name
Relationship to you*
Phone Number*
Payment Information:

Full payment is due at the time of service and a deposit may be needed prior to
treatment depending on the services provided. We accept, cash, and most major credit cards.
Authorization of Ownership:

I authorize the following people to act as owner in my absence and on my behalf for any of my pets listed in my
medical record at KFVP. The decisions these people are able to make include, but are not limited to,
authorizing medical treatments/procedures required or recommended for my pet(s), authorizing the financial
obligation that is a direct result of the treatment/procedure they authorized, consent or decline any DNR (Do
Not Resuscitate) clause or euthanasia. I understand that the people below must be over 18 years old as they are acting on my behalf. I also understand that any costs accrued on my account are payable by me as I am the
official owner of my pet(s) listed as patients at KFVP

Mitchell Animal Clinic

Your Pet’s Integrative Vet

Client Information:

Additional Contact:

Payment Information:

Authorization of Ownership:

Prior Veterinary Care: