DocFaris.com

Alto Lino
Boquete, OO 00000

(816)830-9778

www.docfaris.com

Before requesting an appointment with Dr. Faris, please read the Holistic Release Form and Payment Policy. Proceeding with a request for an appointment verifies that you have read and do agree with the terms of the Holistic Release Form and Payment Policy.

To make an appointment for a consultation with Dr. Faris, please fill out and submit the New Client Registration Form. The program will display a "Thank You" message when the document has been properly submitted.  Subsequently, we will contact you with scheduling options.

Thank you very much.

New Client Registration Form

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Phone number (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
How did you hear about Dr. Faris and DocFaris.com? (required)

Patient species limited to dogs and cats (required) :
Animal Name (required)

Sex (required)
Male
Female
Spay/Neutered
Description(i.e. longhair, white with black spots) (required)

Breed/Mix (required)

Age (required)

Please list current problems and symptoms (required)

Release Form (required)
I have read and agree to the Holistic Release Form, and Payment Policy listed under "New Clients".
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