New Client Registration Form
Welcome to our hospital! Our mission is: "... to be there for our clients by providing unparalleled medical care in an atmosphere of uncompromising compassion so our patients live long and healthy lives."
Owner's Name
*
First Name
Last Name
Date
*
/
Month
/
Day
Year
Today's Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
Occupation:
Employer:
Work Phone Number:
Is there an additional owner? If yes, what is the relationship to the owner?
*
Type "No" if there is not an additional owner.
Additional Owner Name:
First Name
Last Name
Additional Owner Phone Number:
-
Area Code
Phone Number
Emergency Contact Name:
*
First Name
Last Name
Emergency Contact Phone Number:
*
-
Area Code
Phone Number
How did you learn about our hospital?
*
Referral
Online Google Search
Drove By
Yellow Pages/Yellow Book
LocalVets.com
Local Shelter or Rescue
Other
If you were referred by another client, whom may we thank?
Please list the client's FIRST AND LAST name.
If Other, please list.
AHDC Appointment Cancellation Policy: No-Show Appointment Policy: A No-Show Appointment is when a client fails to be present at their scheduled appointment time without a phone call, text, or email within at least 24 hours of a scheduled appointment. A $50.00 fee will be added to accounts for existing clients who do not show for scheduled appointments and an invoice will be sent via email on file. The full obtained deposit for new clients will be forfeited for those who do not show for scheduled appointments. By signing this form, you agree to our appointment cancellation policy.
We pledge to do our very best to care for your pet's health needs. In return we ask you to accept the responsibility for charges incurred in the treatment of your pet. Payment is required at the time services are rendered. We accept all major credit cards, cash, checks, and CareCredit. We may also require deposits for certain services. By signing this form, you agree to pay for all charges incurred in the care of this pet. .
Submit
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