Thank you for choosing Center for Animal Health as your pet’s healthcare provider. We are proud to treat your pets as if they are our own.

Date(Required)

Owner Name(Required)

Second Contact Name(Required)

Address

Address

City

State

ZIP Code

Primary Phone:

Second Contact Phone

Email Address(Required)

What is your preferred contact method?

Call

Text Message

Pet Information

Pet Name(Required)

Species(Required)

Canine

Feline

Age

Breed

Sex

Has your pet been spayed or neutered?

Yes

Coloring

Optional

Weight

lbs

If there are additional pets in your house that you would like to add to your current medical record, please let a staff member know and they will assist with making any necessary changes.

Do you have pet insurance?

Yes

If yes, what company are you using?

Do you consent to your pet’s image being shared on our website or social media?

Yes

Payment is expected when services are rendered. For your convenience we accept all major credit cards including MasterCard, Visa, Discover, and American Express. As an additional service to our clients, we also accept CareCredit. CareCredit provides an interest-free payment plan for veterinary care if the balance is paid within six months. There are no upfront Costs, no annual fees, and no prepayment penalties. If interested, ask our staff about a CareCredit application.

I, the undersigned, verify that to the best of my knowledge, the information provided above is accurate.

Owner’s Signature

New Client Information Form

Pet Information