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New Client Form

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New Client Form

Thank you for entrusting Cypress Veterinary Clinic for your pet’s care! Please fill out our new client registration form in its entirety. A member of our team will be in touch with you shortly. We look forward to meeting you!

Name *

First

Last

Would you like to add another name to the account? *

Name *

First

Last

Email *

Primary Phone *

Type of phone number *

Home
Cell
Work

Secondary Phone

Type of phone number

Home
Cell
Work

Preferred method of communication

Email
Text
Call

Address *

Address Line 1

Address Line 2

City

State

Zip Code

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

Pet Information

Pet's Name *

Species *

Dog
Cat
Other

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Male Neutered
Female
Female Spayed

Does your pet have a microchip identification? *

Microchip Identification Number *

Add a second pet? *

Pet's Name *

Species *

Dog
Cat
Other

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Male Neutered
Female
Female Spayed

Does your pet have a microchip identification? *

Microchip Identification Number *

Add a third pet? *

Pet's Name *

Species *

Dog
Cat
Other

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Male Neutered
Female
Female Spayed

Does your pet have a microchip identification? *

Microchip Identification Number *

Add a fourth pet? *

Pet's Name *

Species *

Dog
Cat
Other

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Male Neutered
Female
Female Spayed

Does your pet have a microchip identification? *

Microchip Identification Number *

Add a fifth pet? *

Pet's Name *

Species *

Dog
Cat
Other

Breed *

Color *

Age/Date of Birth *

Sex *

Male
Male Neutered
Female
Female Spayed

Does your pet have a microchip identification? *

Microchip Identification Number *

Previous veterinarian information

Who was your previous Veterinarian? *

Please provide name, address, and phone number.

Do we have permission to call your previous veterinarian for records? *

If your appointment is for a second opinion, we require the records from all facilities that saw your pet, 48 hours in advance for the doctor to review the case.

Drag & Drop Files, Choose Files to Upload

Social Media Policy

Patients may be shown off using a picture, name, or age on social media (Facebook, Instagram, or our website). If you do not want us to share your super cute puppy or cat, please let us know! *

I agree
I disagree

We auto-record your visit so we don't miss important information. Do you give us permission to do so? *

I agree
I disagree

Do you give us permission to release your pet's medical records to pet rescues, shelters, other veterinary hospitals, groomers, and pet daycares that request your pet's medical information? *

I agree
I disagree

Prescription Policy

We can fill medications here at Cypress Veterinary Clinic or provide a written prescription for clients with a current Veterinary-Client-Patient-Relationship (VCPR), which means your pet was examined by a veterinarian with in 6 months to 1 year. We do not fax or call any pharmacy. *

I have read and understand

Click here to read our prescription policy.

We value everyone’s time! We ask that you arrive 10 minutes BEFORE your schedule appointment time to allow for us to review records, go over paperwork and to start on time. *

I have read and understand

There is a $30.00 technician fee for all technician appointments in addition to the service or procedure performed. *

I have read and understand

We apply a 3% surcharge to credit card transactions which does not exceed our cost of processing. Debit cards are not surcharged. *

I have read and understand

Payment is due in full at the time of service. Payment plans or delayed billing are not available. *

I have read and understand

Cypress Veterinary Clinic strives for a positive work environment for our clients and staff. We require the staff and clients to treat each other with respect and kindness. We are all in this together for the safety and wellbeing of your beloved pet(s). There is a 2 strikes you’re out policy regarding ill treatment of our staff. The second warning is the last and we will mail your pets medical records to you. *

I have read and understand

NO SHOW POLICY: This policy has been established to help us serve you better. It is necessary for us to make appointments to see our patients as efficiently as possible. No-shows and late cancellations cause problems that go beyond a financial impact on our practice. When an appointment is made, it takes an available time slot away from another patient. No-shows and late cancellations delay the delivery of care to other animals, some who are quite ill. A “no-show” is missing a scheduled appointment. A “late-cancellation” is canceling an appointment without calling us to cancel within 24 hours of an office appointment or 72 hours in advance of a procedure. We understand that situations such as medical emergencies occasionally arise. These situations will be considered on a case-by-case basis. For all No-Show appointments or late cancellations, all future appointments/rescheduling will require PRE-PAYMENT of the exam fee. It will then be applied as a credit to your invoice, otherwise, it is non-refundable. *

I have read and understand

Checkboxes *

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Ready to visit?

Our mission is to provide high-quality compassionate medicine while maintaining and nurturing the human-animal bond.

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have a question?

Get in touch! Complete our form, and a member of our team will be in touch with you shortly.

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Address

753 West Cypress Street
Kennett Square, PA 19348

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Contact

E: info@cypressvetcare.com
P: 1-484-734-0686

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Hours

Mon, Tues, Wed, Fri: 8 am – 6 pm
Thurs: 8 am – 5 pm
Sat & Sun: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

Checkboxes *

By checking this box, you consent to receive calls, emails, and SMS messages from Cypress Veterinary Clinic. For more information, please review our Privacy Policy. Reply STOP to unsubscribe from SMS messages. Messaging and data rates may apply.

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