Owner's name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Preferred phone number *

Is this a cell phone? *

Yes
No

Alternate phone number

Email *

May we send email reminders? *

Yes
No

Spouse / Partner

First

Last

Phone

Emergency Contact *

First

Last

Phone *

Patient Information

Patient name *

Breed *

Age or Date of Birth *

Color or Markings *

Sex *

Male
Neutered Male
Female
Spayed Female

Previous Veterinarian *

How did you hear about East Asheville Family Vet? *

If you selected family/friend/neighbor, who may we thank? *

Social Media Consent *

I grant East Asheville Family Vet and it’s employees permission to take photographs of myself and/or my pet, and to publish those photographs for any lawful purpose, including, but not limited to, their website, social media accounts, and promotional materials, either digital or in print, in perpetuity. I also grant permission to use my name and/or my pet’s name.
I DO NOT grant East Asheville Family Vet and it’s employees permission to take photographs of myself and/or my pet.

Please read and sign below:

I understand that all fees are due when services are rendered. I may pay with cash, check, credit card, Care Credit or Scratchpay. There will be a service fee, in addition to any banking fees, for any returned checks. Should my account be referred to an independent collection agency, I understand that I am responsible for any additional cost such as collection fees, attorney fees and court costs. I hereby waive my rights of exemption under the law of the state of North Carolina and any other state.

Signature *

Clear Signature

Date *

Yes, we are OPEN for prescription refills and limited services. Our phones are down, but you can email us or use the PetDesk App. Located at 739 Tunnel Rd.

Hours

East Asheville Family Vet Online Forms

New Client Form

Patient Information

Please read and sign below:

Hours

Get Directions

Get in Touch