PATIENT REGISTRATION FORMDate MM slash DD slash YYYY Owner’s Name* Spouse/Other Address Street Address City State / Province / Region ZIP / Postal Code Home Phone*Cell Phone*Work PhoneEmail* Previous Vet By providing my e-mail address, I hereby give City Petcare Hospital and its patrons consent to contact me. Please note that most of our reminders come via text message or e-mail. By signing this form you give your consent to be contacted.Pets InformationPets NameSpecies (Dog/Cat)BreedSex (F/M)Spayed/Neuter (Yes/No)ColorDate of Birth/Age I assume responsibility for all charges incurred in the care of these animals. I also understand that these charges must be paid at the time of release and that a deposit may be required. I understand that City Petcare hospital is an environmentally friendly establishment and therefore I authorize the use of text messages for reminders regarding my account and pets.How did you hear about us? Owner Signature* EmailThis field is for validation purposes and should be left unchanged.
