New Client Information

Name*

PrefixFirst NameLast Name

Secondary Owner/Spouse/Relative

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Preferred Contact Number

Cell PhoneHome PhoneWork Number

YesNo

Secondary Owner Number

Email - This is used for communication between you and your Dr. or their technician. We also send email reminders, appointment reminders and clinic updates.

example@example.com

Drivers License Number - This is needed to report to the state when controlled substances are used or dispensed

Date of Birth - Yours, not your pets. This is used for Senior Discounts and controlled substances

Payment is due when services are rendered. Please be aware that we accept, Cash, Check, Care Credit, Visa, Mastercard, Discover and American Express. We are unable to provide any form of payment arrangements.

Client Code of Conduct

At Serenity Animal Hospital, we are committed to providing compassionate and high-quality care for your pets. To ensure a positive and respectful environment for all clients, staff, and animals, we kindly ask that all visitors adhere to the following guidelines:

Professionalism & Respect

We expect all interactions—whether in person, over the phone, or via email—to remain courteous and professional. Disrespectful, aggressive, or abusive behavior, including shouting, threats, or inappropriate language, will not be tolerated. Our staff members are dedicated to helping you and your pet. Please treat them with kindness and patience, just as they do with you.

Collaboration & Communication

We value open and respectful communication. If you have concerns or questions about your pet’s care, we encourage you to discuss them calmly with our team. Disruptive behavior that hinders our ability to provide care to other clients and their pets may result in refusal of service.

Zero Tolerance Policy

Any form of verbal abuse, harassment, or physical intimidation toward staff or other clients will result in immediate action, including the possibility of being asked to leave and/or refusal of future service.

Our goal is to provide the best possible veterinary care in a safe and welcoming environment. We appreciate your cooperation in maintaining a respectful atmosphere for everyone.

By signing below, I certify that each animal listed on this account is owned by me, or that I have verified legal authorization to act on the owner’s behalf. To help us provide the best care, I understand that all pets on my account must belong to me or have confirmed permission from the legal owner. If questions regarding ownership or authorization arise, I acknowledge that the clinic may request additional information and may delay or decline services until ownership or authorization can be verified. at Serenity Animal Hospital.

Thank you for being a valued client at Serenity Animal Hospital.

Sincerely,
The Doctors and Staff

I have read and understand the Client Code of Conduct and Ownership Declaration*

Pets Name #1

Dog or Cat

Please Select one

Male or Female

Please Select One

Breed

Color

Date of Birth

Any Past or Present Medical Conditions/Known Allergies

Current Medications

Anything else you would like to tell us?

Pets Name #2

Dog or Cat

Male or Female

Breed

Color

Date of Birth

Any Past or Present Medical Conditions/Known Allergies

Current Medications

Anything else you would like to tell us?

Pets Name #3

Dog or Cat

Male or Female

Breed

Color

Date of Birth

Any Past or Present Medical Conditions/Known Allergies

Current Medications

Anything else you would like to tell us?

Serenity Animal Hospital Client Information