"*" indicates required fields

Are you a Current Client or New Client?*
Have we seen this patient before?*
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Name*
Primary number will receive text appointment reminders and be the first point of contact.
Appointment type*
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Spouse/Secondary Owner Full Name
Address*
Sex*
Is Your Cat Spayed or Neutered?*
Is your cat declawed?*
Is your cat?*
I am responsible for having records emailed to catstaff@verizon.net or faxed to 610-398-4486 upon booking.*
I certify that I am at least eighteen (18) years of age and am the legal owner of the cat(s) listed above. I authorize the veterinarian(s) of Allentown Cat Clinic, PC to examine, diagnose, treat, prescribe and provide routine veterinary care for my cat(s). I accept responsibility for all charges incurred in the care of my cat(s) and understand that payment is due at the time services are rendered unless prior arrangements have been made. I further understand that I will be responsible for any additional costs or fees incurred for collection processing should this account become delinquent. I certify that the information provided on this form is accurate and complete to the best of my knowledge. I understand that my electronic signature has the same legal effect as an original handwritten signature.*
I understand that a booking fee of $50.00 per patient ($150 for surgeries) will be collected upon scheduling. Due to limited availability, this fee would be due by end of business day or the appointment will be cancelled. Additional charges will be paid at the time of release unless prior arrangements have been made. This fee will be applied to your appointment. This fee is non-refundable should you change or cancel with less than 24 hours notice.*
I authorize Allentown Cat Clinic, PC to use photos and/or videos of my cat(s) for any promotional materials regarding Allentown Cat Clinic, PC programs, facilities or services. Such likenesses will not be sold to other parties. Promotional materials bearing these likenesses may be distributed for free to the public and posted on the Allentown Cat Clinic website and/or social media platforms. The Allentown Cat Clinic, PC reserves the right to use any photo or likenesses for a time period beginning when this form is signed and ending upon written request of the owner of this cat.*
Notice of Audio and Video Recording: For the safety, training, and quality assurance of our patients, clients, and team members, Allentown Cat Clinic, PC utilizes audio and video recording in various areas of the hospital. These recordings may include both visual and sound-based capture of interactions, including but not limited to client communication, telephone calls and patient care activities. By signing below, you acknowledge that you have been informed of the use of audio and video recording within the facility and grant permission for Allentown Cat Clinic, PC to record and store such footage for lawful and appropriate use, including quality assurance, training, and internal review purposes. We take privacy and confidentiality seriously and ensure that all recordings are handled in accordance with applicable laws and hospital policy.*
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