New Client Form

New Client Form

Before your first visit to Out West Veterinary Center in Conway, please complete the form below with your contact information, your pet’s medical history, and current medications. Submitting this form does not schedule a visit; use our online appointment page to book an appointment.

Owner Information

Pet Information

CPR Authorization

If CPR is authorized, I understand that I am responsible for the cost of resuscitation and that success cannot be guaranteed.

Authorization for Treatment, Risks & Emergency Care

I certify that I am the owner of the above-named pet, or an authorized agent of the owner, and have the authority to consent to veterinary care. I authorize the veterinarians and staff of Out West Veterinary Center to examine, diagnose, and treat my pet as they deem necessary. I understand that due to alternating schedules, the veterinarian responsible for my pet’s care may change during treatment.

I acknowledge that all medical procedures, anesthesia, and surgical treatments carry inherent risks, including the possibility of serious complications or death. While every effort will be made to provide safe and effective care, no guarantee has been made regarding the outcome of treatment.

I understand that unexpected medical conditions may arise requiring immediate treatment. Staff will make reasonable efforts to contact me before performing additional services. If I cannot be reached in a timely manner, I authorize the veterinarians and staff of Out West Veterinary Center to provide any medical treatment they deem necessary for my pet’s health and safety. If CPR is performed, I understand that resuscitation efforts are not guaranteed to be successful.

I also understand that any dog under one year of age that is not fully vaccinated and is showing symptoms of parvovirus (vomiting or diarrhea) must remain outside the hospital until a negative parvo test is confirmed. A $100 deposit is required before a technician performs the initial exam and parvo test.

Financial Responsibility, Deposits & Payments

I understand that a deposit equal to the low end of the estimate may be required prior to treatment for drop-off, walk-in, or emergency visits, and that this deposit will be applied toward the final invoice. I understand that pre-anesthetic bloodwork is required for procedures involving anesthesia to help minimize risk.

I understand that payment is due in full at the time of discharge and that Out West Veterinary Center does not offer in-house payment plans. Unpaid balances may be given to a collections agency, and failure to pay may result in denial of future services.

Hospital Policies

For the safety of staff and clients, disrespectful or threatening behavior will not be tolerated and may result in denial of services. Please note that video and audio surveillance systems are always in use on the premises.

If boarding services are provided, first-time boarding stays must be paid in full at the time of drop-off. Boarding stays lasting two weeks or longer require a 25% deposit at drop-off, with the remaining balance due at pick-up.

Media Release: I authorize Out West Veterinary Center to take photographs and/or videos of my pet for advertising, promotional materials, or social media.

Clear Signature
By signing above, I confirm that I am the financially responsible party for the above-named pet and agree with the policies listed above.