901 W. Centennial Blvd. Springfield, OR 97477

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Cascade Animal Clinic

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Click-to-call 541-741-1992
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New Client Form

CASCADE ANIMAL CLINIC

New Client Form

Save time during your next appointment! Complete your required new client form online from any device at any time before your visit.

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a second pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a third pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fourth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fifth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed (copy) *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your Pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your Pet. We accept Cash, Visa, MasterCard, Discover, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made. *

I have read and accept the financial policy.

Phone

Contact Information

Address: 901 W. Centennial Blvd. Springfield, OR 97477

Phone: (541) 741-1992

Email: Reception@CascadeAnimal.com

Find Us On:

Business Hours

Monday – Wednesday:	8:00 am – 6:00 pm
Thursday:	8:00 am – 12:00 pm 2:00 pm – 6:00 pm
Friday:	8:00 am – 5:00 pm
Saturday & Sunday:	Closed

Contact Us

Have a question? Complete this form to get in touch.

Name *

First

Last

Email *

Phone

How can we help you? *

Website

We proudly serve the pets of Springfield, OR, and the surrounding areas:

Springfield
Eugene
Coburg
Pleasant Hills
Junction City
Creswell

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