Online Forms

We offer our patient forms online so you can easily complete them before your scheduled visit in the convenience of your own home. Click on the links below to download the forms as a PDF. Complete and return the forms to our Country Veterinary Clinic in the Live Oak, Yuba City area at your pet's next visit.

Required form for all new patients:

New Client Intake Form - Download Here
New Client Intake Form

Welcome to our office! Thank you for making Country Veterinary Clinic the place for all of your pet care needs. So that we may become better acquainted, please complete the following:

REGISTRATION
Owner*:
Spouse:
Address*:
City:
State:
Zip:
Home Phone*:
Cell Phone:
Work Phone:
Spouse's Work Phone:
Place of Employment:
Spouse's Place of Employment:
How did you hear about our clinic?
Personal Recommendation: If so, whom shall we thank?
ANIMAL INFORMATION
Pet's Name:
Breed:
Color:
Date of Birth:
Age:
Gender:
Does your pet have any current or prior illness or injury?
Is your pet currently on medication or supplements?​​​​​​​
PET 2

Pet's Name:
Breed:
Color:
Date of Birth:
Age:
Gender:
Does your pet have any current or prior illness or injury?
Is your pet currently on medication or supplements?​​​​​​​
AUTHORIZATION
Payment Information

Payment is due at the time of service. Payment may be made in cash, check, debit, or credit card (VISA, MASTERCARD, DISCOVER).
​​​​​​​
Who will be responsible for authorizing procedures, and/or paying for services?
Name:
Date:
CANCELATION POLICY

I understand I will be billed a $35.00 fee for each patient, for any scheduled appointment, not canceled within 24 hours of appointment time.
Name:
Date:

Additional Form:


Ear Crop Waiver Form - Download Here

Ear Crop Waiver Form

Owner*
Pet Name*
As the owner or agent of the owner of the above-named animal, I hereby give my consent to Country Veterinary Clinic to perform an EAR CROP SURGERY on the above-named pet.

By signing below I acknowledge the following:

  • The cost of the surgery includes surgery and suture removal only.
  • The estimated cost for the surgery is $580.00.
  • A non-refundable deposit in the amount of $100.00 is required prior to scheduling the appointment.
  • All aftercare is the responsibility of the owner.
  • Cropping the ears is not a guarantee that the ears will stand. The ears standing is entirely dependent upon the owner’s aftercare.

I understand that the $100.00 deposit is non-refundable and will be forfeited if not used for this specific ear crop surgery.

I verify that the above-named animal has had, or will have, at least two (2) puppy vaccinations prior to the surgery.

I understand that to perform this surgery anesthesia is required. Furthermore, I understand that problems can arise due to pre-existing conditions not visually evident and that results cannot be guaranteed. I agree to hold Country Vet Clinic harmless from and against any and all liability arising out of the performance of any of the procedures referred to above.

Full payment is required at the time of service.
Signed:
Name*
Date*