Clone of Veterinary New Client Registration Form

Welcome!

Thank you for considering Kachemak Bay Animal Hospital for your pet's needs. Please complete this form so we can set up your account and prepare for your pet’s visit.
Have you ever brought a pet to Kachemak Bay Animal Hospital before?
Owner's Name

First NameLast Name
E-mail
Phone Number:

Area CodePhone Number
Home Address:

Street Address

Street Address Line 2

CityState

Zip Code
Is your mailing address the same as your home address?
Mailing Address:

Street Address

Street Address Line 2

CityState

Zip Code
Preferred Contact Method
Authorized Person — Optional
Would you like another person to be able to discuss your pet’s care and make decisions on your behalf?
If Yes: Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship
I authorize this person to discuss my pet’s medical care and make treatment decisions on my behalf. I understand that I remain financially responsible for services they authorize.

Welcome!