We would like to welcome you and your pet to the El Paseo Animal Hospital family and thank you for choosing us to care for your pet. Please complete the following form prior to your appointment.
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Client Information
Owner Name
*
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized Contacts
Would you like to add authorized contacts to your account? Please note, only authorized contacts on the account will be able to bring your pet in and authorize treatments.
Authorized Contact #1
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Would you like to add in another authorized contact?
Yes
No
Authorized Contact #2
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Would you like to add in another authorized contact?
Yes
No
Authorized Contact #3
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Would you like to add in another authorized contact?
Yes
No
Authorized Contact #4
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
About My Pet
Pet #1 Name
*
Species
Breed (if known)
Sex
Female
Female Spayed
Male
Male Neutered
Current Medications
Pre-Existing Medical Conditions
Additional Comments?
Do you have another pet to add?
Yes
No
Pet #2 Name
*
Species
Breed (if known)
Sex
Female
Female Spayed
Male
Male Neutered
Current Medications
Pre-Existing Medical Conditions
Additional Comments?
Do you have another pet to add?
Yes
No
Pet #3 Name
*
Species
Breed (if known)
Sex
Female
Female Spayed
Male
Male Neutered
Current Medications
Pre-Existing Medical Conditions
Additional Comments?
Do you have another pet to add?
Yes
No
Pet #4 Name
*
Species
Breed (if known)
Sex
Female
Female Spayed
Male
Male Neutered
Current Medications
Pre-Existing Medical Conditions
Additional Comments?
Late Policy
At El Paseo Animal Hospital, we make every effort to start your appointment on time. Since we do often have a full schedule, we ask you to help us by arriving for your appointments on time.I understand that El Paseo Animal Hospital is not always able to accomodate late appointments. If I am late for my appointment, I understand I may have to wait until my pet can be seen, change my appointment to a drop off appointment, or reschedule my appointment. I understand that El Paseo Animal Hospital will determine which option is available based on that day's schedule.
*
Yes, I understand.
Please initial here.
*
Social Media
El Paseo Animal Hospital occasionally posts pictures of pets on our social media sites. No personal information is included in these posts. I give El Paseo Animal Hospital permission to post pictures of my pet on social media:
*
Yes
No
Please initial here.
Medical Authorization
I certify that I am over 18 years old and I am the owner of the above animal. I hereby authorize the El Paseo Animal Hospital veterinarians to examine, prescribe, and treat my animal(s) under your care. I assume responsibility for all charges incurred by the care of my pet(s), and I understand that payment is due in full at the time services are rendered. I understand a deposit may be required for all surgical procedures and all patients admitted into the hospital.
Signature
*
Today's Date
*
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Month
-
Day
Year
Date
Submit
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