Animal Medical Center

New Client Form

Thank you for giving us the opportunity to care for your pet. We’ll be happy to answer any questions
you have about your pet’s health. To ensure the best care possible, please take the time to fill out this
form completely.

Owner: *

First

Last

Address *

Address Line 1

City

State

Zip Code

Cell Phone

Spouse/Other Cell Phone

Email Address *

How did you learn of our clinic?

Social Media
Internet Search
Sign

If recommended, by whom?

Reason for your visit today

PETS HEALTH HISTORY

Name of pet

Dog/Cat/Other

Sex

Male
Neutered Male
Female
Spayed Female

Breed

Color

Birthdate

Pets Current Medications

Is your pet on a Prescription Diet?

Please check here for consent to post pets pictures on our Website and/or Facebook page

I hereby authorize

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical and hospital treatment

Signature

Clear Signature

Date

Message

Animal Medical Center

New Client Form

New Client Form

PETS HEALTH HISTORY

Ready to visit?

We Can’t Wait to See You and Your Pet

Have a question?

Address

contact

Hours