329 Clofton Drive, Nashville, TN 37221
(615) 646-7387
Mon-Fri: 7:30 AM - 6:00 PM
Close
Home
About
Our Team
Services
Wellness Program
Sick Pets
Surgical
Dentistry
Boarding
Resources
Forms
Online Store
Our App
Contact
New Client Form
Please complete our New Client Form.
Call Now to Book
Download Our App!
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Home Phone
Work Phone
Cell Phone
Email
*
Employer's Name
Spouse / Other Name
Spouse / Other Employer's Name
Spouse Cell Phone
Emergency Contact
How did you hear about our clinic?
Yellow Pages
Hospital Sign
Internet
Friend / Relative / Neighbor
Other
If "Other" is selected, please specify
Pet Information
Pet Name
Species
Canine
Feline
Birthdate
Breed
Color
Sex
Male
Female
Neutered / Spayed
Yes
No
Date Of Last Vaccines
Neutered Name /
Hospital Last Visited
Client understands and agrees that payment in full is due upon services rendered and that a deposit may be required in some cases. Because HHAH invoices at the time of the visit, on the odd occasion a fee may be overcharged or left off the original invoice. Either way, as soon as an error is found, it will be corrected and you will be informed as soon as possible. Checks over $100.00 are not accepted unless client leaves a valid credit card with expiration date on file. If said services are not paid for, then the client agrees to pay service charges and a minimum billing charge of $3.00 per month. Client further understands that should this account be placed for collections, client agrees to pay all costs of collection including, but not limited to collection fees, reasonable attorney fees and court costs. There is a minimum $30.00 fee for all returned checks.
Signature
Clear Signature
Submit