{"id":3611,"date":"2024-05-03T17:40:32","date_gmt":"2024-05-03T17:40:32","guid":{"rendered":"https:\/\/www.southsideanimalclinic.com\/?page_id=3611"},"modified":"2024-05-03T17:48:18","modified_gmt":"2024-05-03T17:48:18","slug":"new-client-form","status":"publish","type":"page","link":"https:\/\/www.southsideanimalclinic.com\/new-client-form\/","title":{"rendered":"New Client Form"},"content":{"rendered":"<p><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script><\/p>\n<div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_6' >\n<div class='gform_heading'>\n<h2 class=\"gform_title\">New Client Form<\/h2>\n<p class='gform_description'>\n<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n<\/p><\/div>\n<form method='post' enctype='multipart\/form-data'  id='gform_6'  action='\/wp-json\/wp\/v2\/pages\/3611\/' data-formid='6' novalidate>\n<div class='gf_invisible ginput_recaptchav3' data-sitekey='6LdZfxInAAAAAGDhjfmQg7QmhadVqjI6NyDa8c0_' data-tabindex='0'><input id=\"input_e5e3b1f4b28fc34530a842900157c22e\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_e5e3b1f4b28fc34530a842900157c22e\" value=\"\"\/><\/div>\n<div class='gform-body gform_body'>\n<div id='gform_fields_6' class='gform_fields top_label form_sublabel_below description_below validation_below'>\n<div id=\"field_6_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_28\" ><label class='gfield_label gform-field-label' for='input_6_28'>First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><\/p>\n<div class='ginput_container ginput_container_text'><input name='input_28' id='input_6_28' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div>\n<\/div>\n<div id=\"field_6_29\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_29\" ><label class='gfield_label gform-field-label' for='input_6_29'>Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><\/p>\n<div class='ginput_container ginput_container_text'><input name='input_29' id='input_6_29' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div>\n<\/div>\n<div id=\"field_6_7\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_7\" ><label class='gfield_label gform-field-label' for='input_6_7'>Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><\/p>\n<div class='ginput_container ginput_container_email'>\n                            <input name='input_7' id='input_6_7' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div>\n<\/div>\n<div id=\"field_6_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_3\" ><label class='gfield_label gform-field-label' for='input_6_3'>Spouse \/ Partner Name<\/label><\/p>\n<div class='ginput_container ginput_container_text'><input name='input_3' id='input_6_3' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>\n<\/div>\n<fieldset id=\"field_6_4\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_4\" >\n<legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>\n<div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address gform-grid-row' id='input_6_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_6_4_1_container' ><br \/>\n                                        <input type='text' name='input_4.1' id='input_6_4_1' value=''    aria-required='true'    \/><br \/>\n                                        <label for='input_6_4_1' id='input_6_4_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label><br \/>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_6_4_2_container' ><br \/>\n                                        <input type='text' name='input_4.2' id='input_6_4_2' value=''     aria-required='false'   \/><br \/>\n                                        <label for='input_6_4_2' id='input_6_4_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label><br \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_6_4_3_container' ><br \/>\n                                    <input type='text' name='input_4.3' id='input_6_4_3' value=''    aria-required='true'    \/><br \/>\n                                    <label for='input_6_4_3' id='input_6_4_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label><br \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_6_4_4_container' ><br \/>\n                                        <select name='input_4.4' id='input_6_4_4'     aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select><br \/>\n                                        <label for='input_6_4_4' id='input_6_4_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label><br \/>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_6_4_5_container' ><br \/>\n                                    <input type='text' name='input_4.5' id='input_6_4_5' value=''    aria-required='true'    \/><br \/>\n                                    <label for='input_6_4_5' id='input_6_4_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label><br \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_6_4_6' value='United States' \/><\/p>\n<div class='gf_clear gf_clear_complex'><\/div>\n<\/p><\/div>\n<\/fieldset>\n<div id=\"field_6_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_5\" ><label class='gfield_label gform-field-label' for='input_6_5'>Primary Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><\/p>\n<div class='ginput_container ginput_container_phone'><input name='input_5' id='input_6_5' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div>\n<\/div>\n<div id=\"field_6_6\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_6\" ><label class='gfield_label gform-field-label' for='input_6_6'>Alternate \/ Spouse Phone<\/label><\/p>\n<div class='ginput_container ginput_container_phone'><input name='input_6' id='input_6_6' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div>\n<\/div>\n<div id=\"field_6_8\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_8\" ><center><\/p>\n<h2>Pet Health Information<\/h2>\n<p><\/center><\/div>\n<div id=\"field_6_9\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_9\" ><label class='gfield_label gform-field-label' for='input_6_9'>Pet Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><\/p>\n<div class='ginput_container ginput_container_text'><input name='input_9' id='input_6_9' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div>\n<\/div>\n<div id=\"field_6_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_10\" ><label class='gfield_label gform-field-label' for='input_6_10'>Approx. Age \/ Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><\/p>\n<div class='ginput_container ginput_container_text'><input name='input_10' id='input_6_10' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div>\n<\/div>\n<div id=\"field_6_14\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_14\" >\n<h3>Please Choose<\/h3>\n<\/div>\n<fieldset id=\"field_6_11\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_11\" >\n<legend class='gfield_label gform-field-label screen-reader-text' ><\/legend>\n<div class='ginput_container ginput_container_radio'>\n<div class='gfield_radio' id='input_6_11'>\n<div class='gchoice gchoice_6_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Dog'  id='choice_6_11_0' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_6_11_0' id='label_6_11_0' class='gform-field-label gform-field-label--type-inline'>Dog<\/label>\n\t\t\t<\/div>\n<div class='gchoice gchoice_6_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Cat'  id='choice_6_11_1' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_6_11_1' id='label_6_11_1' class='gform-field-label gform-field-label--type-inline'>Cat<\/label>\n\t\t\t<\/div>\n<\/div>\n<\/div>\n<\/fieldset>\n<fieldset id=\"field_6_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_12\" >\n<legend class='gfield_label gform-field-label screen-reader-text' ><\/legend>\n<div class='ginput_container ginput_container_radio'>\n<div class='gfield_radio' id='input_6_12'>\n<div class='gchoice gchoice_6_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Male'  id='choice_6_12_0' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_6_12_0' id='label_6_12_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n<div class='gchoice gchoice_6_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Female'  id='choice_6_12_1' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_6_12_1' id='label_6_12_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div>\n<\/div>\n<\/div>\n<\/fieldset>\n<fieldset id=\"field_6_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_13\" >\n<legend class='gfield_label gform-field-label screen-reader-text' ><\/legend>\n<div class='ginput_container ginput_container_radio'>\n<div class='gfield_radio' id='input_6_13'>\n<div class='gchoice gchoice_6_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Spayed'  id='choice_6_13_0' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_6_13_0' id='label_6_13_0' class='gform-field-label gform-field-label--type-inline'>Spayed<\/label>\n\t\t\t<\/div>\n<div class='gchoice gchoice_6_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Neutered'  id='choice_6_13_1' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_6_13_1' id='label_6_13_1' class='gform-field-label gform-field-label--type-inline'>Neutered<\/label>\n\t\t\t<\/div>\n<div class='gchoice gchoice_6_13_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Unaltered'  id='choice_6_13_2' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_6_13_2' id='label_6_13_2' class='gform-field-label gform-field-label--type-inline'>Unaltered<\/label>\n\t\t\t<\/div>\n<\/div>\n<\/div>\n<\/fieldset>\n<div id=\"field_6_16\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_16\" ><label class='gfield_label gform-field-label' for='input_6_16'>Breed<\/label><\/p>\n<div class='ginput_container ginput_container_text'><input name='input_16' id='input_6_16' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>\n<\/div>\n<div id=\"field_6_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_17\" ><label class='gfield_label gform-field-label' for='input_6_17'>Color<\/label><\/p>\n<div class='ginput_container ginput_container_text'><input name='input_17' id='input_6_17' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>\n<\/div>\n<div id=\"field_6_18\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_18\" ><label class='gfield_label gform-field-label' for='input_6_18'>What Heartworm and Flea Prevention is Your Pet On?<\/label><\/p>\n<div class='ginput_container ginput_container_text'><input name='input_18' id='input_6_18' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>\n<\/div>\n<fieldset id=\"field_6_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_19\" >\n<legend class='gfield_label gform-field-label' >Is Your Pet Being Treated for Any Illness or Chronic Disease?<\/legend>\n<div class='ginput_container ginput_container_radio'>\n<div class='gfield_radio' id='input_6_19'>\n<div class='gchoice gchoice_6_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Yes'  id='choice_6_19_0' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_6_19_0' id='label_6_19_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n<div class='gchoice gchoice_6_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='No'  id='choice_6_19_1' onchange='gformToggleRadioOther( this )'    \/><br \/>\n\t\t\t\t\t<label for='choice_6_19_1' id='label_6_19_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n<\/div>\n<\/div>\n<\/fieldset>\n<div id=\"field_6_20\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_20\" ><label class='gfield_label gform-field-label' for='input_6_20'>Please Specify Problem(s), and Any Medication Your Pet May Be On<\/label><\/p>\n<div class='ginput_container ginput_container_textarea'><textarea name='input_20' id='input_6_20' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div>\n<\/div>\n<div id=\"field_6_22\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_22\" ><label class='gfield_label gform-field-label' for='input_6_22'>Any Known Allergies?<\/label><\/p>\n<div class='ginput_container ginput_container_textarea'><textarea name='input_22' id='input_6_22' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div>\n<\/div>\n<div id=\"field_6_23\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_23\" >\n<p>It's completely normal for some pets to feel anxious in new environments, and we want to ensure their safety and the safety of our staff throughout the visit. If you're unsure or if your pet has any specific needs or behaviors, we should be aware of, please don't hesitate to let us know. We're here to make this experience as comfortable as possible for both you and your furry friend.<\/p>\n<\/div>\n<div id=\"field_6_24\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_24\" ><label class='gfield_label gform-field-label' for='input_6_24'>Name of Previous Veterinary Clinic<\/label><\/p>\n<div class='ginput_container ginput_container_text'><input name='input_24' id='input_6_24' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>\n<\/div>\n<div id=\"field_6_25\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_25\" ><label class='gfield_label gform-field-label' for='input_6_25'>Phone Number for Record Request<\/label><\/p>\n<div class='ginput_container ginput_container_phone'><input name='input_25' id='input_6_25' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div>\n<\/div>\n<fieldset id=\"field_6_26\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_6_26\" >\n<legend class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex' ><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>\n<div class='ginput_container ginput_container_consent'><input name='input_26.1' id='input_6_26_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_6_26_1' >I agree to pay in full for services rendered. 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