• New Client Form

    Thank your for giving Ward Animal Hospital the opportunity to care for your pet(s). So that we may become better acquainted, please complete the following. Fields marked with a red asterisk (*) are required.

  • Pet Owner Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Emergency Contact Information

    Please enter information for someone other than yourself. We ask for this information for your safety. Who would need to be contacted in case of an emergency for yourself?
  • Format: (000) 000-0000.
  • Please read carefully and select one:*

  • First Animal Information

  • Type of Pet*
  • Gender*
  • Would you like to add a second animal?*

  • Second Animal Information

  • Type of Pet*
  • Gender*
  • Would you like to add a third animal?*

  • Third Animal Information

  • Type of Pet*
  • Gender*
  • Would you like to add a fourth animal?*

  • Fourth Animal Information

  • Type of Pet*
  • Gender*

  • Care Authorization and Account Information

  • Is there anyone other than your spouse authorized to bring animals for treatment under your account?

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Please indicate your preferred payment method(s):

  • Please read the following carefully:

     

    • I/We hereby authorize the veterinarians to examine, prescribe for, or treat my pet(s).
    • I/We assume full responsibility for all charges incurred in the care of this/these animal(s).
    • I/We also understand that all fees are due at the time services are provided.
       

    By signing below, I/we are acknowledging and agreeing to these terms.

     

  • Today's Date*
     - -
  • Should be Empty: