New Client Information Form

Owner Name - First Name

Owner Name - Last Name

Spouse Name

Address - Street Address

Address - Street Address Line 2

Address - Apt

Address - City

Address - Postal / Zip Code

Preferred Contact #

Employer Name

Employer Contact #

Email Address

Would you prefer to be contacted by Email or Text?

Initial

Signature (type full name as signature)

How were you referred to us?

How would you prefer to be contacted?

Text Email Both None

May Hamilton Plaza Animal Hospital use your pet’s photo or video on its social media pages or website?

Yes No

Our office uses Scribble AI recording software during appointments. May we record conversations regarding your pet for accuracy?

Yes No

Signature(Type full name as signature)

1st Pet Name

Dog / Cat Breed

Sex

Date of Birth

Color / Markings

Another Pet?

2nd Pet Name

Dog / Cat Breed

Sex

Date of Birth

Color / Markings

Another Pet?

3rd Pet Name

Dog / Cat Breed

Sex

Date of Birth

Color / Markings

Proudly Privately Owned & Operated