info@accvetclinic.com

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About Us
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  - New Client Form
Book Appointment

Home
About Us
- Our Team
- Careers
- Contact
Services
Resources
- Online Forms
  - New Client Form
Book Appointment

Animal Care Center Veterinary Clinic

New Client Form

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

2 cats

New Client Form

Please note, a deposit may be required to schedule your first appointment. If you have any questions place contact us.

Your Name *

First

Last

Spouse's Name

First

Last

Email *

Cell Phone Number *

Home Phone Number

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Driver's License # and State *

Your Employer *

Work Phone Number

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

Spouse's Employer

Spouse's Work Phone Number

Employer Address

Address Line 1

Address Line 2

City

State

Zip Code

How did you become aware of our clinic? *

QwestDex Yellow Pages
Drive By (sign)
Our Website (accvetclinic.com)
Ziplocal Yellow Pages
Other

If you were referred by someone, who should we thank?

May we have your permission to contact you via e-mail with information about promotions, appointment reminders, test results, posting pictures on Facebook, Instagram, Twitter etc? If not, we will contact you by regular mail or telephone. *

Yes
No

May we have your permission to contact you via text message with information about promotions, appointment reminders, test results, posting pictures on Facebook, Instagram, Twitter etc? If not, we will contact you by regular mail or telephone. *

Yes
No

Pet Infomation

Pet's Name *

Pet's Species *

Dog
Cat

Pet's Breed *

Pet's Age *

Sex *

Male
Neutered male
Female
Spayed Female

Previous Veterinarian

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Payment Information

What method of payment will you be using for today's charges? *

Cash
Check/Debit
Mastercard
Visa

I will assume full responsibility for all charges incurred in the care of my animals. I also understand that all charges will be paid in full at the time of discharge and that a deposit may be required to schedule your first appointment, surgical procedures and hospitalized pets. *

I have read and accept the financial policy.

I have carefully read and agree to all of the above statements.

Date *

Website

We Proudly Serve The Pets In Salem, OR, and Beyond

It is our mission to partner with our clients to nurture and preserve the human-animal bond by providing compassionate, expert, and affordable veterinary care from your pet’s first adventure throughout a long and healthy life.

Book Appointment

Have a Question?

Our team is here to help! If you have any questions, please don’t hesitate to call us directly at 503-371-1988.

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Location

5498 Commercial St. SE
Salem, OR 97306

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Contact Information

Phone: 503-371-1988
Fax: 503-371-3900
Email: info@accvetclinic.com

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Hours

Mon-Fri: 8 am-12 pm & 1 pm-5:30 pm
Sat & Sun: Closed

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After-hours Emergency Care

Salem Veterinary Emergency Clinic:
503-588-8082
Wilvet 24 hour hospital:
503-741-8858

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