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Client Registration Form
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September 11, 2026
CLIENT DETAILS
First Name
Last Name
Phone
PET DETAILS
Name
PRODUCT DETAILS
Product
Quantity
Comments
In accordance with the Privacy Act, I understand my rights to privacy and that personal information will not be released without my consent. I consent and authorize the disclosure of necessary personal and medical information required when communicating with other veterinarians, specialists and other relevant third parties.
In accordance with the Privacy Act, I understand my rights to privacy and that personal information will not be released without my consent. I consent and authorize the disclosure of necessary personal and medical information required when communicating with other veterinarians, specialists and other relevant third parties.
I understand full payment is due at the time services are rendered. If I am unable to pay in full, I must notify Petzoic Vet team prior to treatment. If my pet stays for the day, I will receive an itemized treatment plan. I understand I must leave a deposit of the high end of the listed amount. Accepted payment forms are cash, credit card (MasterCard and Visa) and debit card.
I understand full payment is due at the time services are rendered. If I am unable to pay in full, I must notify the Petzoic Vet team prior to treatment. If my pet stays for the day, I will receive an itemized treatment plan. I understand I must leave a deposit of the high end of the listed amount. Accepted payment forms are cash, credit card (MasterCard and Visa) and debit card.
I certify that all the information provided is correct and that I am 18 years of age or older. I have read & understand the above payment information & agree to the payment terms.
I certify that all the information provided is correct and that I am 18 years of age or older. I have read and understand the above payment information and agree to the payment terms.
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