Palmetto Veterinary Hospital  

Palmetto Veterinary Hospital

2443 Hwy 17 N
Mount Pleasant, SC 29466

(843)881-9915

palmettovet.net

New Client Check In

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.

New Client

Name & Email (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Home Phone

Cell Phone

Place of Employment

Work Phone

E-Mail Address :
Method Of Payment
Paid By:
(All Professional Fees are due at the time services are rendered)
Cash
Check
Credit/Debit Card
Care Credit


Pet Information
Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed:

Color:

Sex: (required)
Male
Female


Neutered/Spayed
Neutered
Spayed


Are your pets vaccines current?
Do you have pets medical records?
Medical records at another veterinary Practice?
Yes
No


Name of Former Veterinary Practice

May we request a transfer of records?
Yes
No


Would you like us to call you for your appointment
Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here

Please Read
I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of the animal. I understand that ALL PROFESSIONAL FEES ARE DUE NOW, unless prior arrangements are made. I also understand a late fee of 1.5% will be added to any account that becomes (30) thirty days PAST DUE and late fees will continue to be charged until your account is PAID IN FULL. Also please be advised that all appointments missed may be subject to a fee of $12.
I have read this statement and - (required)
I Agree
I Disagree



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Palmetto Veterinary Hospital
2443 Hwy 17 N
Mount Pleasant, SC 29466
(843)881-9915