Client Form Client InformationYour Name*Spouse's Name*Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Preferred Phone*Spouse's PhoneEmail* Employer*Alternate Contact for Emergencies*Whom may we thank for referring you or How did you find us?*I give my Consent for media display of my pets (Digital Screen/Facebook/Website)* Yes NoPet Information - please list all pets in householdPet #1: Pet's Name*Species* Dog Cat BirthdateSex* Male Female Spayed / Neutered?* Yes No Color*Breed*Any other information we should know about this pet? (i.e. ongoing medical issues, allergies, temperament problems)Pet #2: Pet's Name*Species* Dog Cat BirthdateSex* Male Female Spayed / Neutered?* Yes No Breed*Color*Any other information we should know about this pet? (i.e. ongoing medical issues, allergies, temperament problems)Pet #3: Pet's Name*Species* Dog Cat BirthdateSex* Male Female Spayed / Neutered?* Yes No Color*Breed*Any other information we should know about this pet? (i.e. ongoing medical issues, allergies, temperament problems)Hospital PoliciesWe routinely prepare a written estimate. All professional fees are due at the time services are rendered. In cases of extensive medical or surgical procedures where full payment may be difficult at discharge we accept Visa, MasterCard, AM and Discover. **Please note that a $5.00 billing fee or 1.5% interest will be assessed monthly to any unpaid balances. There will be a service charge of $30.00 and loss of check writing privileges for any check returned unpaid. There is a $5.00 processing fee for credit card transactions less than $15.00. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges must be paid at the time of release and that a deposit may be required for treatment. We do require 24 hour notice for cancellations of any appointments including boarding reservations. We may assess a $25 charge for any cancellations with less than a 24 hour noticeClient Signature*Date* MM slash DD slash YYYY Enter the code below