Horizon Veterinary Service
11152 West S.R. 18
Delphi, IN 46923
(765)564-3400
info@horizonvet.com
Hours: Mon. Wed. Tu. Fri.: 8am-6pm
Th.: 8am-8pm
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Horizon Veterinary Service
Caring for pets and their people since 1990

Welcome to Our Site

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 your cooporation in letting us assist you.

Form - 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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