New Client Form

We are honored to have you and your furry friend! If you would like to make an appointment, you can assist us to expedite your check in by submitting this form. Thank you for your cooperation in letting us assist you. Fields marked with an * are required.

Name
Preferred primary phone contact
Secondary Name on Account
Or, How did you find out about us?

Please list your top 3 preferred dates and times for an appointment

Method of Payment:

Please Read: I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Rock Bridge Animal Hospital and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Rock Bridge Animal Hospital's collection agency, and will incur a $35 collection fee for which I am liable, in addition to monthly finance charges.

A $50 booking fee will be collected to hold my appointment spot for me. This fee is NON-refundable if I cancel my appointment with less than 24 hours notice. This fee will be applied towards my invoice if my appointment is kept as scheduled. I can cancel my appointment by calling (573) 859-4503.

I have read the above statements and:

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