Clone of Client Registration Form

Welcome!

Please complete this form so we can add your new pet to your account and prepare for their care.
Have you ever brought a pet to Kachemak Bay Animal Hospital before?
Owner's Name

First NameLast Name
Phone Number:

Area CodePhone Number

Digital Scribe

To help our veterinary team focus more on you and your pet, we may use a secure digital scribe to assist with medical documentation. When used, visit conversations may be recorded and processed for the purpose of creating or assisting with your pet’s medical record.
May we use a digital scribe during your visits?
Authorization
- I confirm that I am the owner of this pet or am authorized by the owner to make decisions regarding this pet’s care.
- I confirm that the information provided above is accurate to the best of my knowledge.
- I authorize Kachemak Bay Animal Hospital to obtain relevant medical records from this pet’s previous veterinary providers.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Photo Permission — Optional

We occasionally share patient photos on our website or social media.
May we use photos of your pet?
Thank you! We look forward to meeting your pet.
Should be Empty:

Welcome!