ACVH New Client Form

Pet #3 Name*
Upload A Picture of Your Pet

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Species*

DogCat
Date of Birth/Age of Your Pet*
Breed & Color (If your cat is not a known breed, do they have long, medium or short hair?)*
Sex*

MaleNeutered MaleFemaleSpayed Female
Is Your Pet Microchipped?*

YesNoI'm not sure
Microchip Number (if known)
Previous Veterinarian(s)*
If none, please let us know that!
Upload Previous Veterinary Records

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This form supports telling us about 3 pets in your home. If you have more than 3 pets, please let our office know and we will send you an additional pet form.

Policies & Information
Have you reviewed the policies listed on our website?*

Yes
TREATMENT CONSENT:

I declare I am the lawful owner of all listed pets and all information is true and correct to the best of my knowledge. I hereby authorize the veterinarian(s) of American Canyon Veterinary Hospital to examine, prescribe for or treat the my pet(s) to the best of their abilities. I assume responsibility for all charges incurred in the care of this animal.

By signing this document I declare that I have read, understand and agree to each of the policies and information listed on our website.
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