Horizon Veterinary Service

11152 West State Road 18
Delphi, IN 46923

(765)564-3400

horizonvet.com

New Client Check In

If you have scheduled an appointment, you can assist us to expedite your check-in by submitting this form.
Thank you for letting us assist you.

New Client

Name & Email (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Daytime Phone (required)
Phone TypePhone Number (required)
Evening Phone (required)
Phone TypePhone Number (required)
E-Mail Address :
How did you hear about Horizon Veterinary Service? (required)
Yellow pages
Website
Other client
Our sign
Other


Who may we thank for referring you to our clinic?

Pet's Name (required)

Age: Years, Months

Type of Pet (required) :
Breed:

Sex: (required)
Male
Female


Neutered/Spayed
Neutered
Spayed


Are your pets vaccines current?
Do you have pets medical records?
Medical records at another veterinary Practice?
Yes
No


Regular/previous veterinarian

May we request a transfer of records?
Yes
No


Would you like us to call you with a reminder for your appointment
Reasons or conditions that prompted your visit?

Special requests or conditions?

Please list any additional pets here

Please Read
I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Horizon Veterinary Service and that charges are due and payable at the time of service, unless other arrangements are made in advance. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Horizon Veterinary Service's collection department, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.
I have read this statement and - (required)
I Agree
I Disagree



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