White Oak Animal Hospital
New Client Registration


Date:
Owner's Name: Spouse/Other:
Children (first names & ages):
   
Address:
City:
State:
Zip:
Home Telephone:
Cell phone:
   
Employer's Name:
Work Phone:
   
Spouse's Employer Name:
Work Phone:
   
In case of EMERGENCY, please call at telephone number

Pet's Name:
Approx. Date of Birth:
 
dog cat other: Sex: Male Neutered Unneutered Female Spayed Unspayed
Breed:
 
Color:
   

How did you first hear of us? Yellow Pages Other:
  Individual we may thank?
Are there any personal issues you would like us to be aware of? (i.e. allergies, claustrophobia, fear of animals)


I assume responsiblity for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment.

If this account becomes delinquent, I hereby agree to pay 33 1/3% attorney fees and all other costs to collect this debt.

Disclosure of Hours

White Oak Animal Hospital is staffed:
Monday, Wednesday and Friday - 7am - 6:30pm
Tuesday, Thursday - 7am - 8pm
Saturday - 9am -1pm

I am aware that the hospital is not continuously staffed overnight.
Arrangements can be made to transfer patients to an overnight facility when necessary.


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