• Client Registration and Consent Form for Vaccination, Hospitalization, Treatment and Other Services

    Valid ID cards must be presented at the Hospital. You must be 18yrs of age or older
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • How did you find out about Dr Kafai Veterinary Hospital?
  • Sex
  • Date of Birth (If available)*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Last Vaccine Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Sex
  • Date of Birth (If available)
     - -
    2 digit month, 2 digit day, 4 digit year

  • If you don't know your pet birthdate please enter their age                      

  • Does your pet have any Pet Health Insurance?*
  • If yes, will you be bringing in a claim form*

  • To prevent the spread of infectious diseases and parasites, hospitalized animals must be current on all vaccines and free of internal and external parasites

     

    For the safety of all pets and people, please keep your pet restrained by leash or carrier at all times. 

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: