NEW CLIENT AND PATIENT INFORMATION FORM

Welcome! Please fill out the information below to assist us in setting up your account. We will confirm receipt of this form and let you know if we need additional information. If you would prefer, feel free to contact us at 805-344-2212 to give us the information over the phone. Thank you, and we look forward to having you join San Marcos Equine.

Name

First Name

Last Name

Main Telephone

(###)

###

####

Mobile Telephone

(###)

###

####

Address

List mailing and physical addresses.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Patient Information

Boarding Facility Name & Contact

Boarding Location

If your horse/s are located at a different address than listed above, please give full address of the facility.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Message

Please add any additional information you think we should know, such as additional names to be on this account.

SME Financial Policy

Our policy is to collect payment in full at time of service. You may keep a credit card on file by contacting our office at 805-344-2212. We accept cash, checks, Visa, MasterCard, Amex, and Discover.

How did you hear about San Marcos Equine?

NEW CLIENT AND PATIENT INFORMATION FORM

NEW CLIENT & PATIENT REGISTRATION