New Patient Registration Form

New Patient Registration Form
Your information
Client First and Last Name*

First NameLast Name
Cell Phone*
Please enter a valid phone number.
Communication Preference*

TextEmailCall
Home Phone
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Apartment Number

CityState

Zip Code
If apartment, which building
Co-Owner

First NameLast Name
Co-Owner Phone Number
Please enter a valid phone number.
Do you have pet insurance?*

yesno
If Yes, Which Company
How did you hear about us?*
if by a current client of ours, please list name
Previous Vet /Phone Number*
Pet Information
Pets Name*
Age/DOB:*
Breed*
Color*
Species*
MaleNeuteredFemaleSpayed
Medical Conditions:*
If none, type N/A
Current Medications:*
If none, type N/A
Pet temperament: *
Photo of your pet*

Cancelof
IF YOU HAVE MULTIPLE PETS, PLEASE FILL OUT THE ADDITIONAL PET FORM LOCATED ON OUR WEBSITE, OR TEXT US AT 615-778-0880 FOR THE LINK
All animals are Subject to be scanned for a microchip and if such microchip is noted, the registry company may be contacted
All payments are required at the time of discharge.

I/we hereby authorize the veterinarians to examine, prescribe for, or treat my pets (s). I/we assume full responsibility for all charges incurred in the care of this/these animal(s). I/we also understand that these charges will be paid in full at the time of release and that a deposit may be required for certain surgical treatments or other procedures. We accept cash, all major credit cards & Care Credit which can be approved in as little as 10 minutes. No refunds, charge backs or cancellations once services are performed.
Pet Restraint Policy

For legal and safety reasons, it is AAAH's policy that a trained staff member or veterinarian will restrain your pet during any/all exam, testing or procedures being performed. It is a non-waiving policy. Owners, children, family members, friends or caretakers MAY NOT hold or restrain their own pet while an exam is being performed. Please do not place your face or hands near an animal’s face during an exam, even if you think you are calming or helping your pet. Rarely, we may require a muzzle restraint for an aggressive pet. This is for the safety of the staff, veterinarian, and of the pet to receive a thorough exam. If you perceive your pet to be anxious or stressed before beginning an exam, a suitable calming medication may be given orally or by injection. The health and safety of our staff, clients, and other patients is of the most importance. We will use all/any precautions to ensure this. Thank you for your understanding.
I have read and understand the above statements and agree to all terms therein*

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Animal Ark Animal Hospital Deposit Policy
For all the following services a client must provide a non-refundable deposit as described with full understanding that this deposit will be forfeit if the policy is not adhered to. This policy is non-negotiable.
New Client: $79 deposit which is non-refundable should the client cancel less than 24 business hours prior to the scheduled appointment time.

Elective Surgery (Spay, Neuter, Mass Removal, Etc.): $100 deposit which is non-refundable should the client cancel less than 48 business hours prior to the scheduled appointment time.

Dentistry/Dental Surgery: $100 deposit which is non-refundable should the client cancel less than 48 business hours prior to the scheduled appointment time.

Tennessee Veterinary Surgical Services: $500 deposit which is non-refundable should the client cancel less than 48 business hours prior to the scheduled appointment time.

Infinity Ultrasound Procedures: $100 deposit which is non-refundable should the client cancel less than 48 business hours prior to the scheduled appointment time.

*Business Hours will not include hours we are closed, which may include, but are not limited to, holidays. Weekend hours are not considered business hours.
This policy is non-negotiable as Animal Ark Animal Hospital is liable for the appointment fees associated with the specialist regardless of whether the appointment is attended. Also note, that should you forfeit your deposit with the specialist they WILL NOT accept your pet as a patient in the future. *

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Animal Ark Animal Hospital L.L.C.
1115 W. McEwen Drive, Franklin, TN 37067
615-778-0880
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New Patient Registration Form

Your information

Pet Information

All payments are required at the time of discharge.

Pet Restraint Policy