New Client Form

WE KNOW YOUR PET’S HEATH IS IMPORTANT AND WE THANK YOU FOR TRUSTING US TO CARE FOR THEM. TO HELP US PROVIDE THE BEST CARE POSSIBLE, PLEASE TAKE A FEW MOMENTS TO FILL OUT THIS FORM COMPLETELY. THANK YOU!

Thank you for making an appointent with us. To help us link your Form with the correct appointment please tell us what day your appointment is on.

Appointment Date*

Date

Name*

Last Name First Name

Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone Number

Please enter a valid phone number.

Cell Number*

Please enter a valid phone number.

Email*

example@example.com

Secondary Name

Secondary Phone Number

Please enter a valid phone number.

How did you hear about us?*

Family/Friend first and last name for $25 pet pals referral:

Owner's D.O.B*

Previous Vet Hospital/or Not Applicable*

Pet's Name*

Type of Pet*

DogCatOther

Breed(Cat breeds; DSH, DMH, DLH or specific breed)*

Color*

Sex*

Male IntactedMale NeuteredFemale IntactedFemale Spayed

D.O.B or Age*

Reason for Visit*

Pet's Name #2

Type of Pet

DogCatOther

Breed (Cat breeds; DSH, DMH, DLH or specific breed)

Color

Sex

Male IntactedMale NeuteredFemale IntactedFemale Spayed

D.O.B or Age

Reason for Visit/ Date of appointment

Treatment*

I understand that every effort will be made to achieve a successful outcome and to provide for all possible safety in hospital care and handling. I hereby authorize this hospital to receive, prescribe for, treat or perform surgery upon the pet(s) listed above. Furthermore, I agree to pay fees for all services rendered at the time the pet is discharged from the hospital or the service is otherwise terminated. I agree to pay for the reasonable costs of collection, attorney fees and court costs in the event that collection efforts become necessary. I agree that the venue of this action will be in the county where the hospital is located. I understand that veterinary service is provided during nighttime hours as necessary in the judgment of the veterinarian in charge. Continuous presence of qualified personnel may not be provided. I am at least 18 years of age and legally liable for any decisions I make.

Photo Release*

We think your pet is PAWS-itively perfect and want everyone to know! By signing this waiver I give Murrieta Oaks Veterinary Hospital & Pet Hotel the right to use the photo(s) and name(s) of my pet provided for reproduction in any promotional medium including but not limited to; website, video, broadcast, print, and electronic means for purposes of advertising, trade, display, exhibition or editorial use. Further, you also (i) agree to release Murrieta Oaks Veterinary Hospital & Pet Hotel from all claims for libel, slander, invasion of privacy, infringement of copyright or right of publicity or any other claim and (ii) confirm that you are over the age of 18 years old.I opt out of social media even though I think my pet(s) are PAWS-itively perfect.

Signature*

Clear

Date*

Date

PET HEALTH HISTORY

AUTHORIZATION