New Client Information Form


New Client Information Form

Please complete the form before your visit. We will get in touch with you if we have any questions.

Additional person to be added and authorized to use account:

Pet information

Email Address/PetDesk App information

We utilize PetDesk App, where you can schedule an appointment, request medication refills, receive reminders for your pets, and receive information about specials, holiday hours, etc. In order to use this smartphone app, you must provide an email address. Please note we never sell your information. Emails are used for patient reminders, newsletters, specials, medication or food recalls, and other important information.

Photo Release

I understand that photographs, digital images of my pet, myself, or my family(excluding minor children) may be used on Robertson County Animal Clinic's website, social media sites, and/or email newsletter for entertainment purposes only and agree to its use in that manner.I, the undersigned, authorize Robertson County Animal Clinic to use such materials for entertainment purposes only. I agree not to file any claim for revenue or lawsuit for damages against this veterinary practice with respect to the release of these images. Please Initial:

Medical Records Release

I hereby authorize and provide my written consent to release medical records of my pets to other veterinary offices, boarding, and/or grooming facilities upon request.


I understand that payment is due at the time of service. Robertson County Animal Clinic does not accept payment plans. Payment methods accepted are Cash, Check (driver license number required), Visa, Mastercard, Discover, and Care Credit.

Clear Signature