New Client Registration Form

Welcome to Horseshoe Lake Animal Hospital!

We value your confidence in us and look forward to serving the healthcare needs of your pet!

Appointment date:

Pet Owner’s Information

Last Name*

First Name*

Title

E-mail*


Address*

County

Home Phone

Work Phone

Cell Phone

Best Method of Contact

May we send you text notifications?

Spouse’s Name

How did you hear about our clinic?

If recommended, whom may we thank?

Pet Information

Name of Pet:

DogCatOther

If other, please specify

Breed:

Color/Markings:

Sex:

Date of Birth/Age:

Date of last known vaccination:

Type of vaccination:

Number of pets:
Dogs
Cats
Other

Reason for your visit today:

Emergency Contact Name:

Phone number

Method of Payment:

Do we have your permission to post photos of you or your pet on social media sites?

Driver’s License Number:

** We will need a Drivers License if paying by Check**

AUTHORIZATION

I HEREBY AUTHORIZE the veterinarians and staff of Horseshoe Lake Animal Hospital to examine, prescribe for, and/or treat the above-described pet. I assume responsibility for all charges incurred in the care and treatment of this pet. I also understand these charges will be PAID IN FULL at the time of discharge and that a deposit may be required.

Yes, I agree to these terms.