New Patient Information

Thank you for entrusting us with another family member! So that we may be better able to meet your needs, please complete the following. 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.

Species:

If Other, Please Specify:
Breed:
Color:
Date of Birth: mm/dd/yy
Your Pet's Gender:
Is your pet Spayed or Neutered?
Microchip:
Tattoo:
Current Medications:
Drug Allergies:
Serious Health Problems (If Any):
Date of Last Exam mm/dd/yy



I (we), the undersigned do hereby grant my permission for the release of any or all of the information contained in the medical record of the pet listed below to be given upon request to the following facilities:



I (we), do hereby grant permission to Oakland Animal Hospital to post my pets photo, name, story, or other items to the Oakland Animal Hospital website or Facebook account.



AUTHORIZATION FOR EXAMINATION, TREATMENT AND ASSUMPTION OF FINANCIAL RESPONSIBILITY I, the undersigned, authorize the veterinarian (s) and their staff to examine the patient described above and to administer any medical, surgical treatments and / or tests, including sedation or anesthesia which is considered necessary based on findings during the course of examinations. I assume responsibility for all charges incurred for services rendered to the patient. I understand there is a $30.00 service charge for returned checks. I also understand that these charges will be paid at the time of release and that a deposit may be required for hospitalization and / or surgery.

 
Signed, (Your Name)
Your Email Address