New Client Information

You will only need to fill out the form you see below once to become a new client of ours.

 

CLIENT INFORMATION

Fields marked with an * are required

Are you interested in alternative medicine for your pet(s)?


PATIENT INFORMATION

Please list all of your pets


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DISCLAIMERS & SIGNATURE:


BY MY SIGNATURE:

I assume responsibility for all charges incurred for services rendered to the patient. Payment or donations are appreciated at the time services are rendered. I understand there is a $35 service charge for returned checks. I understand that any deposits paid for services will go towards the service on the day scheduled, and are nonrefundable or transferrable. I give my permission for the staff of Natural Veterinary Services, Inc to obtain any medical records that may pertain to my pet(s). These records may be collected from any hospital or clinic that my pet(s) has visited in the past or may visit during my time as a client here, and is not limited to any specific ailment or treatment. I have read and understand the disclaimer on the PREVIOUS page.

Disclaimer statement: I understand that the FDA has not evaluated the efficacy of Bicom Bioresonance, homeopathic remedies, and natural cures. Many holistic products and services offered are not intended to diagnose, treat, prevent, or cure any disease.