New Patient Form

Patient Registration

Name(Required)
Address(Required)
Has Your Pet Been Spayed or Neutered?
Has Your Pet Been Vaccinated?
Is Your Pet Currently Taking Medication?
Does Your Pet Suffer From Allergies?

Over the last few weeks canine flu has infected many dogs. Because of this many clinics in the Birmingham area have had contamination issues. At Grayson Valley Pet Clinic, we try to be sure that all our patients are protected. To do this, we will ask that you respond to the following statements. Please check all that apply.

In the last week my dog has not:

If you cannot agree with the above statements, boarding or grooming will not be allowed at this time. If your dog needs to be seen by one of our doctors, they will be happy to do what they can under our outside tent. Thank you for understanding that we want to keep your dog and others safe and healthy.

Form of Payment(Required)

Failure to make payment is basis for legal action to be taken and by clicking to agree to these terms you are agreeing to pay all court costs and reasonable attorney’s fee, and hereby waives all rights to exemption under the laws of the State of Alabama, or any other state.

Consent(Required)