Name*
Spouse's Name
Home Address*
City*
State*
Zip Code*
Primary Phone Number*
Secondary Phone Number
Email Address*
Pet's Name*
Date of Birth (or approximate age)*
Breed*
Colors & Markings*
Gender MaleFemale
Altered Neutered MaleSpayed Female
Microchipped YesNo
If Microchipped, what is the number
Has your pet had any recent vaccinations? If so, when and where?
Would you like us to send you a reminder when your pet's vaccines are due? YesNo
Who can we thank you for referring you to us?
Financial Policy: All About Pets Hospital requires payment in full for professional services rendered at the time of discharge from the hospital unless arrangements have been made in advance for payment. Terms: Net 30 days from the date of the invoice unless otherwise indicated. A finance charge of 1.5% per month (APR 18%) of the unpaid balance will be added monthly. Should collection become necessary, the responsible party agrees to pay an additional 40% collection fee, and all legal fees of collection, with or without suit, including attorney fees and court costs.
As the legal owner or responsible agent of the above animal(s), I certify that I have read and agree to the above financial policy. I hereby assume financial responsibility for all services rendered.