New Pet Form

OWNER'S INFORMATION

Name*:

Phone Number*:

PET’S INFORMATION

Please give any previous records to the receptionist so we may copy them for our records.

Pet

Has your pet had any of the following

Current Medications

Is your pet current on their rabies?

AUTHORIZATION

I hereby authorize Animal Health Clinic to examine, prescribe for and treat my pets. I assume responsibility for all charges incurred in the care of my animals. I also understand that these charges will be due at the time of release and that a deposit may be required for surgical treatment or hospitalization. We will gladly prepare a written estimate for your pet's care at any time. Just ask one of our staff members.