Client Registration

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Preferred Phone Number

Please enter a valid phone number.

Phone Type

CellHome

Would you like to receive text message reminders and communications?

YesNo

Alternate Phone Number

Please enter a valid phone number.

Phone Type

CellHome

Email

example@example.com

Client Occupation

Please list any other individuals that you authorize to make decisions regarding your cat (Must be over 18 years of age).

Name of First Individual

First NameLast Name

Phone Number

Please enter a valid phone number.

Occupation

Name of Second Individual

First NameLast Name

Phone Number

Please enter a valid phone number.

Occupation

How did you hear about us?

If someone referred you, tell us their name so we can say Thank you!

Authorization

I hereby authorize Just For Cats, Inc. and its agents to examine, prescribe for and treat each of my animals from this day forward. Further, I authorize Just For Cats, Inc. to acquire medical records from my pets previous Veterinary Office’s. I understand that fee estimates are approximations of expected medical costs and can vary significantly. We will attempt to contact you regarding significant change in treatment/fees as they occur. Payment is expected at time services are rendered. All charges must be paid in full prior to discharge. We accept Cash, Visa, Mastercard, Discover, and American Express.

I have read the above authorization and agree to the above terms. I have also reviewed the following informational links from the Cornell Feline Health Center : Feline Zoonotic Diseases and Feline Vaccines, Benefits & Risks.

Felina Zoonotic Diseases

Feline Vaccines, Benefits & Risks

Signature

Date