New Client Form

Fill out the form below if you’re wanting to join The Pet Mechanic Family!

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The Pet Mechanic New Client Form

Please fill out the form as completely and as accurately as possible so that we may better assist you.

Name *

First

Last

Preferred Pronouns

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Which location will you be visiting? *

Fishtown location
South St. location

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

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

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Payment is due in full at the time that services are performed. If it is necessary for your pet to be admitted into the hospital for extended care, we cannot begin helping until you have confirmed your desire to do so by signing the client consent & estimate form. This is the only way that we have of knowing for certain that you want us to proceed with the care of your pet. We accept Cash, Visa, MasterCard, Discover, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

Message

Fishtown

South Street

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New Client Form

The Pet Mechanic New Client Form

We’re Excited to Meet You

Questions?

Fishtown

South Street

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