Arden Animal Hospital

1823 Fulton Avenue
Sacramento, CA 95825

(916)485-5412

ardenanimalhospital.com

New Client Information Form

Owner's Name (required)

Co-Owner's Name (if applicable):

Address (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
E-Mail Address (required) :
Occupation and Employer: (required)

Preferred form of contact: (required)
Email
Text
Phone Call


Phone Numbers: Please list in the order you would like us to use when contacting you (required)

How did you hear about our hospital? (required)
Google
Yahoo
Hospital Sign
AAHA
Our Website
Yelp
SAAC
Family/Friend
Other


May we use photos of your pet(s) for educational/promotional purposes? (required)
Yes
No


Name of Pet: (required)

Species (required)
Dog
Cat


Breed: (required)

Color: (required)

Date of Birth: (required)

Gender (required)
Male
Neutered Male
Female
Spayed Female


Authorization
I hereby authorize Arden Animal Hospital to examine, prescribe, treat, or perform surgery upon the described pet(s). I also consent to the administration of such anesthetics as necessary. Furthermore, I agree to pay fees for services rendered at the time the pet(s) is discharged from the hospital or when service is otherwise terminated. Arden Animal Hospital is authorized to humanely dispose of said animal(s) unless, I the owner, or an authorized agent of mine, calls for and pays all accrued charges on the animal(s) with 14 days after written or oral notification has been given that the animal is ready to be released from the hospital. I authorize the sharing of veterinary medical information between veterinarians or facilities for the purpose of diagnostics or treatment of my pet(s) who is subject of the medical records. I further understand that veterinary services may not be provided during nighttime hours.
I agree with all of the above: (required)
Yes
No



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