Client InformationFirst Name *Last Name *Spouse First NameSpouse Last NameStreet Address *Address Line 2City *State *ZIP *Phone Number *Spouse PhoneEmail Address *Employer *If necessary, may we contact you at work? *YesNoHow did you hear about us? Who/what may we thank for referring you? *What is your preferred method of being contacted? *EmailPhoneTextPatient InformationPet's Name *Type of Pet *Breed *Date of Birth *Sex *MaleFemaleSpayedNeuteredColor *Is your pet on heartworm prevention? *YesNoIs your pet on flea prevention? *YesNoHas your pet been tested for viruses? *YesNoAre there any other pets in your household? *YesNoPrevious medical records can be obtained from:Would you allow us to release immunization records to boarding kennels and grooming facilities? *YesNoWould you allow us to release your name, address and phone number(s) to someone who has found your lost pet(s)? *YesNoDo you grant Artemis Veterinary permission to use photos/videos of your pet on social media and/or for promotional purposes? *YesNoDo you have pet insurance? Ask us how we can help you submit your claims! *YesNoBy checking the box below, you agree to our financial and payment policies: *Yes, I agree with the financial and payment policiesSubmit New Client Information