COUNTRYSIDE ANIMAL CLINIC
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  • About Us
    • Veterinarians
  • Services
    • Wellness Exams
    • Vaccinations and Microchips
    • Dentistry and Surgery
    • X-Ray and Ultrasound
    • Medications and Diet
    • Laboratory Services
    • Large Animal Services
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    • Client Forms
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Client Forms

    Client Information Form

    Thank you for giving us the opportunity to care for your animals. To help us better serve you, please complete the following:
    * Indicates required field

    Pet Information

    Additional Pet Information

    TERMS
    We accept cash, check (SSN required) , Debit card, Visa, MasterCard, Discover, and American Express. 
    Client agrees to pay a service charge of 1.5% per month plus a $1.00 per month billing fee - 18% per annum on account not paid in 30 days. 
    If this account is assigned to an outside agency for collections, I/we agree to pay all attorney's fees, court costs, process service fees, filing fees, and any other charges or fees, up to 40% that may be assessed by any collection agency retained to pursue this matter with or without suit.
    Collection procedures will be started 60 days after the date of service.
    Please type your name here. This will serve as your signature to agree to the terms stated above.
Submit

Helpful Info

Office hours
Monday 8:00 am to 5:30 pm
Tuesday 8:00 am to 5:30 pm
Wednesday 8:00 am to 5:30 pm
Thursday 8:00 am to 5:30 pm
Friday 8:00 am to 5:30 pm
​Saturday Closed

Sunday Closed

Get In Touch

Countryside Animal Clinic
254 South Main St
Tooele, UT 84074
Phone: (435) 882-4100

Our Partners In Care

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  • Home
  • About Us
    • Veterinarians
  • Services
    • Wellness Exams
    • Vaccinations and Microchips
    • Dentistry and Surgery
    • X-Ray and Ultrasound
    • Medications and Diet
    • Laboratory Services
    • Large Animal Services
  • Client Center
    • Client Forms
    • Petly
  • Contact