New Client Form Thank you for requesting an appointment to become part of the AHBC family. Our preliminary New Client Form will take some basic information. We’re excited to get to know you and your pet!Pet Parent's Name*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*Second Phone*Email Your Pet's Name*Your Pet's AgeSpeciesCanineFelineAvianExoticOtherBreedSex*MaleFemaleIs your pet neutered or spayed?NeuteredSpayedDo you have your pet's medical records?YesNoDoes your pet have records at another vet?YesNoPrevious VetMay we request a transfer of records?YesNoWould you like us to call you to confirm your appointment?YesNoIs your pet having any health or behavioral issues? Please describe.Is there anything else you would like to discuss at your new pet visit? We're listening!Please Read By indicating I agree and submitting this form, I understand I am responsible for any charges incurred by my pet while in the care of Animal Hospital at Brier Creek and that charges are due at the time of service unless other arrangements are made in advance. Any balance carried over a period of 30 days will accrue a monthly finance charge of 1.5%, or 18% per annum. Any balance I leave unpaid will be forwarded to Animal Hospital at Brier Creek'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.*I AgreeI DisagreeEmailThis field is for validation purposes and should be left unchanged.