Existing Client Update Form

Existing Client Information Update Form
Thank you for continuing to allow us to provide care to your pet(s). In order to ensure your information is up-to-date and accurate. Please take a moment to fill out this form.
Today's Date

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Additional Account Name (i.e. spouse/ partner)

First NameLast Name
Phone Number (i.e. spouse / partner)
Email*
example@example.com
Do you already have an appointment? *
If referral/ other, please specify:
Pet's name*
Pet species*
Pet breed
Pet color
Pet Birthdate, if known

MonthDayYear
Date
Pet age (best guess is fine)
How long has your pet lived with you?
Where did you obtain your pet?
What is the gender of your pet? Spayed or neutered? *
Medical history:
Chronic conditions, allergies, medications, supplements
Any medical records can be emailed to auroraveterinary@gmail.com. Please provide us the name, phone number, city and state of your pet's previous veterinary clinic and phone number. If your pet hasn't been to a veterinary clinic yet, please bring any previous records with you to their appointment or upload in the section below.
Please upload any previous medical history

Cancelof
Do you have insurance for your pet? If so, please provide insurance name:
Our Code of Conduct:

I understand that Aurora Animal Care Center is a healing environment, and respectful communication and collaboration between our team members and you, our client, is essential to provide optimal patient care. I understand that just as I would expect empathy, patience, honesty, and kindness from the team at AACC, our team is deserving of the same.

There is ZERO TOLERANCE for all forms of aggression and disruptive behavior both verbal and physical. Such behavior will result in termination of the veterinary-client-patient relationship.
Select to agree: *

I understand and agree to abide by the Client Code of Conduct
I am the owner and hereby authorize the veterinarian to examine, prescribe for or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges must be paid in full, at the time of release of the pet.
Signature:

Clear
Should be Empty:

Existing Client Information Update Form