New Client Info Sheet in San Diego, CA | Turquoise Animal Hospital

OWNER’S NAME*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

PET OWNER’S DATE OF BIRTH*

E-MAIL ADDRESS*

PRIMARY PHONE*

Circle One:*

Home
Cell
Work

ALTERNATE CONTACT NAME / RELATION:

PHONE

How did you hear about us?*

Web
Drive by
Friend

Website:*

Friend's Name:*

First Last

PAYMENT IS DUE AT TIME OF SERVICE. WE DO NOT HAVE ANY FORM OF PAYMENT PLAN.

Please circle your preferred method(s) of payment:*

(WE DO NOT ACCEPT CHECKS)

PET INFORMATION*

Pet's Name	Specie	Breed	Date Of Birth	Color / Markings	Sex M/F	Spayed / Neutered	Allergies Y/N

Please include all pets, including exotics (birds, reptiles, rabbits, hamsters, etc.) – we see them too!

Client Information*

I understand that annual examinations are strongly recommended for all pets for early detection of problems, discussion of vaccine protocols and needs/hazards and other recommendations.

I also certify that I am at least 18 years old and I am the owner or lawful caretaker of these and other pets presented to Turquoise Animal Hospital for any and all medical care.

I authorize the use of my pet’s images in Turquoise Animal Hospital’s Facebook page, newsletters, website and in-hospital digital displays unless stated otherwise.

I understand and agree.

OWNER'S SIGNATURE*

DATE*