New Client Registration - Arnold Veterinary Hospital

Name

Home Phone

Cell Phone

Work Phone

Address

City

State

ZIP / Postal Code

I grant consent for Arnold Veterinary Hospital to use my pet(s)' image for marketing or promotional material, either digital or print.

Name

Species

Canine Feline Other

Breed

Color

Date of Birth or Age

Sex

Male Female

Has the pet been neutered?

Yes No

Has your pet received vaccines or other veterinary services at another facility?

Yes No

If so, please provide us a copy of their most recent vaccine history, or if you do not have a written record, please provide us the name of the facility where services were received so that we can contact them. Your signature on this form signifies your permission for us to obtain this information.

Payment is expected at the time services are provided. The hospital accepts Visa, MasterCard, Discover, in-state checks, as well as cash. A $35.00 service fee will be applied to all returned checks. Balances over 30 days will be subject to interest at a rate of 1 ½% per month. Should your account be placed for outside collections, you will be charged reasonable collection costs, which may include but are not limited to collection agency fees, court costs, and attorney fees, etc.

**PLEASE BE ADVISED THE HOSPITAL IS NOT STAFFED DURING NON-BUSINESS HOURS. **

Signature

Date

New Client Form