Southgate Veterinary Hospital

(701) 298-9455

1415 32nd Ave S Fargo, North Dakota 58103

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New Client Form

"*" indicates required fields

Client Information

Name*
(home or cell)
Address*
Spouse Name

Patient Information

Sex*

Previous Veterinary Services

Address
Previous medical history under your name?
Name*
No previous medical history?

***Disclosure Statement: I understand to make an appointment as a new client at Southgate Veterinary Hospital, a monetary deposit for the exam will be charged when scheduling. Deposits will be applied to your account balance and any remaining balance will be due at the time of service.

Any rescheduled appointments that don’t provide 24-hour notice or no show appointments, will forfeit the deposit.

Allow 48 hours for Customer Service Representative to contact you to schedule an appointment.

**In order to better schedule your appointment and make sure we allow enough time for your pet’s needs; we need to have previous medical history before scheduling your appointment.

This field is for validation purposes and should be left unchanged.

Southgate Veterinary Hospital

Phone: (701) 298-9455 Address: 1415 32nd Ave S Fargo, North Dakota 58103

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