New Client FormCLIENT REGISTRATION FORM Today’s DateNameAddressHome PhoneWork PhoneCell PhoneE-mail Address Spouse/Co-owner’s NameEmergency ContactCellHow Did You Hear About Us?Horse’s NameDate Of BirthSexMaleFemaleBreedColorCurrent Medications/allergiesPrevious Veterinarian Fromwhom Records May Be RequestedI dodo notAuthorize advanced equine to use my/my horses image for social Media/website/promotional use.I hereby authorize the veterinarians to examine, prescribe for or treat horses that belong to me or are under my direct care.I assume responsibility for all charges incurred in the care of these animals, including consultation fees for telephone, verbal and written communications and fees for any documentation including outside prescriptions. All unpaid balances will accrue a finance charge of 1.5% per month and a $3.00 billing charge. In the event that fees are not paid as delineated above, I agree to pay any and all collection and/or attorney’s fees incurred:If paying by check please include drivers license numberSignature Of Owner Or Agent