We look forward to meeting you!

Name: Cadence Animal Hospital
Address: 1190 E. Sunset, Henderson, NV, 89011, United States
Telephone: 702-485-5200
Price range: $

New Client Form

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Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Spouse/Co-Owner

First

Last

Relationship

Spouse/Co-Owner Phone

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

Pet's Name *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Microchip # *

Color/Marking *

Add another pet? *

Pet's Name *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have microchip identification? *

Microchip Number *

Color/Markings *

Do you have pet insurance? *

Name of Previous Veterinary Hospital or Doctor

City and State

May we request your pet's health records?

Any previous illness or surgery?

Please explain. *

Any allergies to vaccinations or medications?

Please explain. *

Do you grant permission for Cadence Animal Hospital to use photos for the purpose of social media post. (Facebook, Website, & Other sites)? *

Yes, I grant permission to use photos on social media and website.
No, I do not grant permission to use photos on social media and website.

Our office does not offer billing. Payment is due at the time of service. We will gladly prepare a written estimate, if you desire. Please ask our doctor during your appointment. Occasionally, a deposit may be required for certain procedures. We accept the following forms of payment: Cash, Personal Check, Credit/Debit (including Visa and Mastercard). *Please note that when writing a personal check, a copy of a valid driver’s license will be needed for processing. There is a $27.00 fee for a returned check in Addition to the fees your bank may charge* *

I have read and understand.

I understand every effort will be made to achieve a successful outcome and provisions will be made for safe in-hospital care and handling. I certify that I am 18 years of age or older and assume responsibility for all charges incurred. I understand that charges are due at the time of services completed, unless prior arrangements have been made. I agree that should my account become delinquent, I will be responsible for all collection costs, including but not limited to the outstanding balance, interest, attorney fees, court costs, and collection agency fees. *

I have read and understand.

I hereby authorize Cadence Animal Hospital to treat my pet(s) and furthermore understand that unforeseeable adverse reactions to treatments are always possible and authorize treatment necessary should any reaction occurs. *