New Client Welcome Form

Welcome! Thank you for giving us the opportunity to meet you and to care for your pet. Completing this form in its entirety will ensure we have accurate information in our veterinary software regarding your pet and his/her health, and that we have current contact information when we need to communicate with you.

New Client

Today's Date

Name *

First

Last *

Last

Email *

Main Phone *

Secondary Phone

Your email and phone numbers are entered into our veterinary software only to communicate with you for your pet’s health reminders, practice information, as well as making and confirming appointments.

Address *

Address

City

State/Province

Zip/Postal

May we feature a picture of you and/or your pet on our social media page? *

Yes

Spouse/Other family authorized to make decisions regarding your pet:

How did you hear about us? * How did you hear about us?

If you chose referred by existing client, please let us know who referred you:

Pet Information

Pet Name *

Species *

Dog

Cat

Sex *

Male

Female

I don't know

Spayed/Neutered? *

Yes

I don't know

Breed *

Color *

Age / Birthday *

What is the reason for your visit?

Do you have a copy of your pet’s vaccine history with you? *

Yes

Your Pet's Vaccine History *

Maximum file size: 52.43MB

If not, may we call your pet’s last veterinary hospital to obtain his/her records? *

Yes

Hospital Name *

Current medications / Health conditions

Add Another Pet Remove

Forms of Payment

Arlington Dog and Cat Hospital accepts payments in the form of Cash, Visa, Mastercard, American Express, Discover Card, Scratchpay, and Care Credit. We no longer accept personal checks.

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 pet. I also understand charges will be paid at the time of release and that a deposit may be required for surgical treatment.

Owner Signature *

Clear

** DUE TO THE NATURE OF THE SERVICES RENDERED IN THIS OFFICE, FULL PAYMENT IS REQUIRED WHEN SERVICES ARE RENDERED. A SUBSTANTIAL DEPOSIT IS REQUIRED FOR HOSPITALIZED PATIENTS. **

***ANIMALS DISCHARGED ONLY DURING OFFICE HOURS***

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