New Client Form

Welcome to Chateau Dog & Cat Hospital!
Help us get to know you by completing the form!

New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please call us at 812-477-8866 for a faster response.
Driver’s license is needed for writing checks and certain medications
Social security number is needed for writing checks and certain medications.
Birthday is needed for writing checks and certain medications.

Pet Information

If known


Financial Responsibility Agreement: I understand that I am responsible for all charges for the care of my pet(s) provided by Chateau Dog & Cat Hospital. I understand that a minimum finance charge of $5.00 monthly, will be charged on any past due balance should the account become 30 days delinquent. I understand a $40 fee will be assessed for any returned checks and added to the account. I understand that if any unpaid balance is assigned to a third-party collection agency for collection or placed with an attorney to obtain a judgment or otherwise satisfy payment of my account a collection fee of 35% will be added to my account. I agree to pay that fee. I further agree to pay reasonable attorney fees and court costs. I understand the above terms.

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Social Media Consent:

We do enjoy taking pictures and videos of our patients and their families. By signing, you authorize the use of such photos and videos for advertising and web use on our website and Facebook page.
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We proudly cater to the Indiana communities of
Mt. Vernon, Boonville, Newburgh, Princeton, and
Ft. Branch, as well as Henderson, Kentucky.

At Chateau Dog and Cat Hospital, we strive to offer our furry patients and their human families a safe, comfortable, soothing environment, and we look forward to continuing to provide you with the highest standard of veterinary care.