New Client Form


How This Works:

 

Please fill out this form with as much information as you can provide.

 

This will help us get your account set up and make your check in process easier and faster!

 

Please contact us with any questions:

Phone: 563-285-7891

frontdesk@risiusfamilyvet.com

  • Hi! Welcome to Risius Family Veterinary Service!

  • About You

  • Please include area code & all numbers we may use to contact you. Please include spouse contact, if applicable.
  • This information will be kept strictly confidential. However, for financial reasons, we are required to ask for this information.
  • Pet Information

  • Name, Breed, Color, Birthdate, Gender, Neutered?
  • Please include all major illnesses, hospitalizations, or surgeries.
  • General Info

    We want to show off our awesome patients! Be sure to "like" us on Facebook or follow us on Instagram! Do we have permission to share your pet's image and story on social media, our website, and other marketing materials?
  • If yes, where? (IE Instagram) What's their handle/name so we can follow!
  • Financial Policy

  • Thank you for choosing Risius Family Veterinary Service! Our primary mission is to deliver the best and most comprehensive veterinary care for your pet. An Important part of the mission is making the cost of optimal care as easy and manageable for our clients as possible by offering payment options. Risius Family Veterinary Service requires PAYMENT IN FULL at the end of your pet's examination and/or at the time of discharge. Any unpaid fees will be subject to an 18% service charge (minimum $4.50) monthly. We will gladly prepare a written treatment plan before services are rendered. If you would like this, please ask any staff member.
  • Payment Options

  • - Cash, Check, Visa, Mastercard, American Express, or Discover Card

    - CareCredit Healthcare Credit Card OR Scratch Pay Pet Payment Plans -- Ask us for more information about these options.

  • Additional Information

  • --Risius Family Veterinary Service charges $30 for returned checks.

    --For clients enrolled in Trupanion Pet Insurance, we offer Trupanion Express, which processes most claims almost immediately. For clients with other forms of pet insurance, we are happy to provide you with the necessary documentation to submit a claim to your insurance carrier.

    --If you have any questions, please do not hesitate to ask. We are here to provide the best veterinary care available for your animal. In accordance with state law and to prevent the spread of infectious diseases, all hospitalized patients must be current on all required vaccines and free from external parasites. A staff member will discuss any necessary treatment with you before it is performed.

  • By signing below, you confirm that the submitted information contained in this form is correct, and you agree to the foregoing terms of payment.