Client Information Form


Owner (must be 18 years or older)

City:   State:   Zip:  
Home Phone:   Work Phone:  
Cell Phone:   Email Address:  

List any and all other people who are authorized to make medical/financial decisions regarding your pets. (must be 18 years or older).

Name & Relationship to Owner Phone

From time to time, we take pictures of our patients. These photos may be displayed on the clinic’s bulletin board, Facebook page, clinic website, or used in advertising or promotional materials. Please initial the appropriate line below to indicate your preference.

Can we use your pet's image?

Yes No

Financial Policy

Thank you for choosing Dewitt Veterinary Clinic. Our primary mission is to deliver the best and most comprehensive veterinary care available 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 several payment options. Dewitt Veterinary Clinic requires payment in full at the end of your pet’s examination and/or at the time of discharge. For your convenience, we accept cash, check, Visa, MasterCard or Discover Card. DeWitt Veterinary Clinic charges $25 for returned checks.

If your situation requires alternate payment arrangements, you may apply for the CareCredit Healthcare credit card. If you are approved, benefits include:

  • Allow you to begin treatment today and pay over time.
  • Available for any treatment amount.
  • Can be used repeatedly- for your entire family- without having to reapply.

For some treatments or hospitalized care, a deposit may be required. Treatment plans requiring comprehensive care of more than $500 will require a 10% deposit to begin your pet’s treatment.

For clients with 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 pet.

By initialing below, you agree to the foregoing terms of payment.

Initials:   Date:  




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Contact Us

2419 260th Ave
DeWitt, IA 52742

Ph: 563.659.5231
Fax: 563.659.3450