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.