New Client Registration in Granville, OH - Equine Veterinary Dental Services

We welcome all new dental clients!
Please complete the following form to establish your new account. If you have not already set up an appointment, be sure to include the questions about scheduling. Thank you!

Name*

Primary Phone #*

Type Of Number*

Secondary Phone #

Type Of Number

Email*

Preferred Method Of Contact*

Stable Name

Trainer's Name

What Service Is Needed?

Veterinarian Name*

Farrier Name*

Friend Name*

All payment is expected at the time of service.
Accepting:

Cash
Check
Credit Card (MC, VISA, AMEX, DISC)
Paypal (link on home page)
CareCredit

Your prompt payment is valuable to this practice to maintain the highest professional level of services at affordable prices. Any charges not paid at time of service may be assessed a finance charge at an annual rate of 24% plus billing fees. Client agrees that if the account should become past due or delinquent, the client will pay all expenses of collection of the account, including but not limited to collection fees, attorney fees, filing fees, court costs and interest.

Thank you for your cooperation in this matter!

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New Client Registration

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