Client Registration Form

Welcome to Oakland Animal Hospital. Thank you for giving us the opportunity to care for your pet. To insure the best care possible, please complete this form. We'll be happy to answer any questions you may have. All information will be kept confidential to protect your privacy. If you would prefer to download a PDF of this form and fill it out by hand, please click here to do so.

Please complete the form in its entirety and click the submit button to insure form delivery.

Client Information

Ms.
Address:
City:
State:
Zip/Postal Code:
Home Telephone:
Work Telephone:
Cell Phone:
E-Mail Address:
Appointment Date: mm/dd/yy

Co-Owner / Spouse Info

Ms.
Home Telephone:
Work Telephone:
Cell Phone:

Referral Information

Were you referred by a friend or a relative? If so we'd love to thank them, please provide their information below:

Phone:
Email:

Refer A Friend

If you'd like to share us with a friend or relative, please enter their information below:

Phone:
Email:

Payment Policy

Full payment is required upon rendering of services. Deposits may be required on major medical/surgical cases, trauma cases and emergency work where hospitalization is required.

Please indicate your choice of payment method

NOTE: A $30.00 CHARGE WILL BE ASSESSED FOR A RETURNED CHECK.

We will gladly prepare a written estimate for services upon your request.

We do not carry open accounts and hope the above alternatives are convenient for you.

E-Mail Reminders, and other Additional Corresponds

I hereby authorize Oakland Animal Hospital to send me newsletters, pet reminders, account statements and other documents via email in lieu of paper whenever possible.

 

Authorization

I assume responsibility for all charges incurred in the care of my pet(s). In the event payment is not received in full, and the account is placed in collections, I understand I will be responsible for any applicable service charges and attorney fees.

 
Signed, (Your Name)
Todays Date mm/dd/yy