info@willitsvet.com | (970) 510-5436 | 351 Robinson St. Suite 1014, Basalt CO 81621

New Client Form

Willits Veterinary > New Client Form

Simply complete the form below to provide us with the details about you and your pet.

If you would like for us to call you to schedule an appointment, please note in the comment section.

Pet Owner's Name*
Cell Phone*
Home Phone
Work Phone
Address
Physical Address Mailing Address City State ZIP Code
Email Address*
Spouse or Co-Owner
Contact Number
Emergency Contact (if different from above)
Phone
Would you like us to:*
- Call you to schedule an appointment
- Add you in our system as a new client
- Respond to you through email
Comments/Reason For Contact*
Pet Information
Name*
Species
Breed
Color
Birthdate
Gender
- Male
- Female
Spayed or Neutured
- Yes
- No
Terms and Agreement*
- I understand that I am financially responsible for all procedures, treatments and diagnostics services performed for my pet. Full payment is due at the time of service. WVH does not offer payment plans.
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Email
This field is for validation purposes and should be left unchanged.

Or download and complete the new client form (PDF) simply by clicking the button below. Send the completed form to info@willitsvet.com and please let us know of any questions.

New Client Form PDF

New Client Form

Pet Information