Thank you for giving us the opportunity to care for your pet. Please help us meet your needs better by taking a moment to share some important information we will need as we support your pet’s needs today and in the future. PLEASE PRINT IN ALL SPACES.

 

Pet parent name: ________________________________________________________________

Address: ___________________________ City_________________ State_______ Zip________

Summer: ___________________________ City_________________ State_______ Zip________

Home phone: ______________________________ Cell phone: _________________________

Work phone: ______________________________   Fax: ______________________________

Email address: ________________________________________________________________

 

Spouse/Significant Other: _______________________________________________________

 

Cell phone: _______________________                       Work phone: _______________________

 

Are any other persons authorized to make medical decisions for your pet(s):         Yes      No

 

Name: ____________________________________            Phone number: _____________________
 

 

Previous veterinarian:_____________________________           Previous vet’s phone: ________________

What pet insurance do you have? ___________________            Do you have Care Credit?      Yes      No

How did you hear about us? ______________________________________________________________

 

To prevent the spread of infectious diseases, all hospitalized and boarded pets must be current on all vaccines and free from internal and external parasites. The signature below authorizes this level of preventive care and the appropriate charges will be itemized in the discharge invoice.

 

We will gladly prepare a written treatment plan if you desire. Please ask us. This will be important to you since ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. We take cash, check (with identification), MasterCard, Visa, Discover, Care Credit and debit cards. There will be a $30 service charge for any check returned unpaid.

 

Signature of Responsible Agent for Pet(s): _________________________________________________________ Date: ___________