New Client Form

By adding a secondary owner, you are giving this individual authority to approve estimates, treatment, surgeries, and euthanasia.

Co-Owner Name (first & last):

Co-Owner Phone Number:

Relationship to Owner

How did you hear about us?

Internet Search

Drive By

Client Referral

Other

If you were referred by a client, what is their name?

Pet's Name*

Age / DOB*

Species*

Breed*

Color

Sex

Female Intact

Female Spayed

Male Intact

Male Neutered

Canine Vaccine Dates

Distemper
Parvo
Bordetella
Lyme
Rabies 1 year
Rabies 3 year

Feline Vaccine Dates

Distemper
Leukemia
Rabies 1 year
Rabies 3 year

Previous Veterinarian and Phone Number*

I understand that my pet’s picture may be used on social media sites.*

YES, you can use my pet's photo on social media.

NO, do not use my pet's photo on social media.

When is your appointment? (Date and time, please)*

Reason for your pet's visit:

I understand and acknowledge that I am responsible for all fees at the time of service. An estimate of services will be provided upon request. Sunridge Animal Hospital does not provide any billing or payment plans. Certain procedures and services may require a deposit (cash or credit card only) with the remaining balance to be paid in full at the time of patient release.

By signing this disclosure, I acknowledge that I have read and agree to the above information and warrant all information provided to be true and correct. I understand and accept full responsibility for all costs incurred. I understand that, in the event that this account should go unpaid, I will be subject to the costs of finance fees, collection fees including but not limited to attorney fees, and collection agency fees.*

Checking this box indicates that I am over 18 years of age and am fully responsible for any charges accumulated.