Two Rivers Pet Hospital

New Client Form

Thank you for choosing Two Rivers Pet Hospital! Please fill out the following form so we can get to know you and your pet before your first visit. If you have any questions, please feel free to give us a call. We look forward to meeting you!

Owner's Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Primary Phone(Required)

Phone Type(Required)

Home

Cell

Secondary Phone

Phone Type

Home

Cell

Spouse's Name

First Last

Spouse's Phone

Employer

Work Phone

How did you hear about us?(Required)

Name of clinic where previous records can be obtained

Pet Information

Pet's Name(Required)

First

Species(Required)

Dog

Cat

Breed(Required)

Approximate Age or Date of Birth(Required)

Sex(Required)

Male

Female

Spayed/Neutered?(Required)

Yes

Date of Last Vaccination

MM slash DD slash YYYY

Brand of Food(Required)

Do you have another pet to add?(Required)

Yes

Second Pet Information

Pet's Name(Required)

First

Species(Required)

Dog

Cat

Breed(Required)

Approximate Age or Date of Birth(Required)

Sex(Required)

Male

Female

Spayed/Neutered?(Required)

Yes

Date of Last Vaccination

MM slash DD slash YYYY

Brand of Food(Required)

Do you have another pet to add?(Required)

Yes

Third Pet Information

Pet's Name(Required)

First

Species(Required)

Dog

Cat

Breed(Required)

Approximate Age or Date of Birth(Required)

Sex(Required)

Male

Female

Spayed/Neutered?(Required)

Yes

Date of Last Vaccination

MM slash DD slash YYYY

Brand of Food(Required)

Authorization and Consent

We require that full payment be made at the time veterinary services are provided. We do not bill and will not accept personal check from new clients. To become an established client, 3 or more paid office visits are required. We do not accept out of state checks. A client/patient who has missed more than half of their scheduled appointments will have to wait and be seen as a work-in appointment.(Required)

I understand the above

As owner I hereby authorize the veterinarian and staff at Two Rivers Pet Hospital to administer such treatment as is necessary and to perform procedures therapeutically and/or diagnostically. I authorize the use of appropriate anesthetics and other medications. I further understand that no guarantee of successful treatment is made. I also assume responsibility for all charges incurred in the care of my animals. In the event of the death of the animal(s) through no fault of the Clinic, I will be responsible for the reasonable costs thereof. Noncompliance of Doctor’s recommendations can terminate the relationship between doctor and patient. I have read and understand this policy and I accept responsibility for all fees. I understand that if I fail to pay as agreed, legal action will be taken against me. I agree to pay any costs incurred in the collection process including but not limited to late charges, attorney’s fees, and a collection agency fee.(Required)

I understand the above

Payment Information(Required)

Cash

Visa

MasterCard

American Express

Bankcard

CareCredit

Please check one

Signature of owner or responsible agent(Required)

Date(Required)

MM slash DD slash YYYY

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Phone

This field is for validation purposes and should be left unchanged.

Make a Veterinary Appointment
Great Falls, MT

Two Rivers Pet Hospital proudly serves the pets of Great Falls, Montana, and surrounding areas. We look forward to seeing you and your pet! You may request an appointment by clicking the button below to give us a call.

Appointment

Contact Two Rivers Pet Hospital

We’re here to help. Please complete the form below, and a member of our team will get back to you as quickly as possible.

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Location

825 6th St SW
Great Falls, MT 59404

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Contact Information

Phone: 406-453-8888
Fax: 406-453-5288
Email: support@tworiverspethospital.com

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Hours

Monday-Friday: 7:30 AM – 6:00 PM
Saturday: Closed
Sunday: Closed

Name(Required)

First Last

Email(Required)

Phone

How can we help you?(Required)

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Name

This field is for validation purposes and should be left unchanged.