Client Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.  Please contact Coastal Veterinary at 302-524-8550 to schedule your pet’s appointment in addition to filling out the registration form below.  

Coastal Veterinary curbside services:
We strive to maintain the highest level of patient and client care in our facility. We ask you to be aware of and respect the following measures we are taking during the COVID-19 pandemic. Upon arriving at Coastal Veterinary Hospital:
🦴 Remain in your car and call our reception office 302-524-8550 to advise of your arrival.
🦴 We will note your arrival time, and lane number you are in and call you back in a few minutes when we are ready for your appointment.
🦴 We will come to your car to retrieve your pet for their appointment and communicate with you via cell phone with any needed information while you REMAIN IN YOUR CAR.
🦴 We will then contact you upon the completion of your pet’s appointment to update you and request payment.

As of Monday, May 16th, 2022: 
    1. Due to the growing volume and demand for appointments in our area, Coastal Veterinary will now be requiring a $40 deposit for all NEW CLIENT appointments. (A NEW         CLIENT is defined as any client that has NOT had a pet examined by one of our staff Veterinarians in 18 months or longer). This fee will go towards your pet’s first physical         exam and invoice. In the event a cancellation is made LESS THAN 24 HOURS before your pet’s scheduled appointment, this fee will cover that missed appointment time. There         will be an additional $40 deposit required once your appointment is rescheduled.

    2. Late Appointments: Your pet’s appointment is a priority at Coastal Veterinary. We make every effort to stay on time. Appointments are considered late if you arrive more than        10 minutes late into your scheduled time. In the event that you are late for your pet’s appointment, you will be asked to either: 

          a. Leave your pet at the hospital so that the Veterinarian may examine your pet, working them in during scheduled appointment hours *, OR
          b. Reschedule this appointment. 

*There will be an additional charge incurred if your pet stays in the hospital while we work this appointment into our schedule.
Our veterinarians and staff want to deliver the very best care for your pet in a timely manner.

PLEASE NOTE: We will continue to see Emergency and Life-Threatening Illnesses as they present themselves throughout the day. In the event of an Emergency, we will do our best to inform you ahead of time so that we may reschedule your appointment to a later time or date.

Please complete this form as fully as possible prior to your first appointment. This will help expedite the registration process and give us valuable insight into providing optimal care for your pet(s). The required sections have an * asterisk.

Client Registration

  • Primary Owner's Information

  • Secondary Owner's Information

  • Pet Information

  • Pet's Current Health

  • >>> Please bring in your pet's medications with you to your appointment.
  • Food brand & Amount fed per day (ex: 2 cups per day)
  • Financial Policy & Authorization

  • Financial Policy

    Coastal Veterinary policy requires payment at time of service. Accepted forms of payment are Cash, Check, Credit (Visa, MasterCard, Discover, or American Express). We can also help you apply for Care Credit financing should the need arise. Information is readily available at the front desk. There is no hospital administered financing program. If you have pet insurance, payment is due at the time of service. Please contact your insurance company for further information.

    A written estimate will be provided at the time of admission. Depending on the nature of medical care, actual cost may vary. We will attempt to contact you as soon as possible if the cost exceeds the high end of the estimate by 20%.

    On admission, a deposit of 50% of the high end of the estimate is required. The balance is to be paid at the time of discharge. We cannot make exceptions to this policy.

    I understand that if there is a balance due, for any reason, and it is not paid per Coastal Veterinary requirements, I will be responsible for any collection and/or attorney fees that are incurred in the attempt to collect the debt.

  • Authorization

    By clicking submit, you agree to the financial policy and hereby authorize the veterinarian to examine, prescribed for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment.