New Client Registration Form

This form can be competed online in advance of your appointment OR in-person at the time of service, either online or in hard copy. The information you provide helps to ensure that your horse(s) receive individualized care plans; please be thorough and detailed.

Please do not use this form to request a Primary Care appointment; call or text (803) 665-8988 to schedule

Name

First Name

Last Name

Phone

(###)

###

####

How do you prefer to be contacted for non-emergent issues?

In case you can't be reached for emergency decision making, please list the name and contact information for an Authorized Decision Maker:

Mailing/Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please provide the following information about your horse:

Name, age, sex, breed, existing conditions or medications, and any other things we should know.

If you have more than one horse, please provide the same information for all horses that Seven Cedars Equine will care for!

Name, age, sex, breed, existing conditions or medications, and any other things we should know.

If your horse(s) is/are stabled somewhere other than the mailing/billing address, please provide their location:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

IF horse(s) is/are stabled at a boarding facility, is the barn/farm/stable manager authorized to seek NON-EMERGENCY veterinary care for your horse?

YES

IF horse(s) is/are stabled at a boarding facility, is the barn/farm/stable manager authorized to seek EMERGENCY veterinary care for your horse?

YES

Submission of this form on the following date indicates that you have read and agree to the New Client Information on the previous page, and understand the terms as discussed.

We look forward to working with you and your horse(s)!

YYYY

New Client Registration Form

Thank you for submitting your New Client Registration form - we look forward to seeing you at our next scheduled appointment!

Seven Cedars Equine