COUNTRYSIDE ANIMAL CLINIC
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    • Veterinarian
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    • Wellness Exams
    • Vaccinations and Microchips
    • Dentistry and Surgery
    • X-Ray and Ultrasound
    • Medications and Diet
    • Large Animal Services
    • Laboratory Services
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    • Client Forms
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  • Home
  • About
    • Veterinarian
  • Services
    • Wellness Exams
    • Vaccinations and Microchips
    • Dentistry and Surgery
    • X-Ray and Ultrasound
    • Medications and Diet
    • Large Animal Services
    • Laboratory Services
  • Client Center
    • Client Forms
    • Petly
  • Contact
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Client forms

    New client 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, debit card, Visa, MasterCard, Discover, and American Express. 
    We CANNOT accept personal checks without a Social Security Number.
    Client agrees to pay a service charge of 1.5% per month- 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.

    Permission to Use Photograph

    I grant permission to Countryside Animal Clinic employees to take photographs of my pet. I agree that they may use the photographs in illustrations, advertising, publicity and web content. 

    I have read and agree to the above statement. 
Submit
Request Appointment

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 8:00 am to 12:00 pm
Sunday Closed

Get in touch

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

Contact us & directions

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