Oakhurst Veterinary Hospital

New Client Form

Welcome to Oakhurst Veterinary Hospital!
Client Information
Name*

First NameLast Name
Spouse or Co-Owner

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home #
Work #
Please enter a valid phone number.
Cell #*
Please enter a valid phone number.
E-mail*
example@example.com
Drivers License #*
State*
Is your address listed as a PO Box?*

NoYes
Please provide a physical address if possible

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a military veteran or first responder?*

YesNo
If you are a military veteran or first responder, please provide proof at your visit.
Pet Information
Pet's Name*
Species*

CanineFelineOther
Breed*
Gender*

MaleFemale
Color*
Spayed/Neutered*

YesNo
Birth Date OR Approximate Age*
Microchip # (If Applicable)
Current on Vaccinations?*

YesNo
Has your pet(s) been seen by a veterinarian in the last five years?*

YesNo
If yes, what hospital can we obtain your pet's medical records from?
Hospital Name*
Phone #*
Please enter a valid phone number.
If you have a copy of your pet's medical records, please upload them here.

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Important Notice: Medical Records Requirement

To ensure the best care for your pet, we require that all medical records be submitted before your scheduled appointment. This includes vaccination records, previous medical history, and any other relevant health information.

Please note that if we do not receive these records prior to the appointment, your appointment will be cancelled and will need to be rescheduled.

Thank you for your understanding and cooperation.
Medical Records Requirements - Client initials:*
Additional Comments/Concerns
Additional Information
How did you hear about us?*

GoogleFacebookMailerWalked/Drove ByInternet -OtherOther HospitalExisting ClientCurrent EmployeeOther
If internet (other), other hospital, existing client, current employee, or other, please list who we can thank.*
Photo Consent: We love social media! Do we have permission to share your pet(s)' image and story on social media, our website, and other forms of related media? Your name and personal information will never be shared. Simply check below to authorize this.*

Yes, I authorize Oakhurst to share my pet's story and photoNo, I do not authorize this.
Treatment Consent: I hereby authorize the veterinarian to examine, prescribe for or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I understand that payment is always due IN FULL at the time of service and that a deposit may be required for hospitalization and surgical procedures. I recognize that financial concerns should be discussed PRIOR to exam and treatment. The Oakhurst staff is happy to provide estimates.

I understand that the Oakhurst Veterinary Hospital does not bill. Acceptable methods of payment are cash, check, Visa, MasterCard, American Express, Discover, and CareCredit. I also understand that if my account is not paid in full that I will be liable for a monthly finance charge of 1.5% and any fees that may be incurred for the services of an outside collection agency.
Signature*

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New Client Form

Client Information

Pet Information

Additional Information