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New Client Form

"*" indicates required fields

Welcome

Thank you for entrusting us with the care of your best friend(s). We also offer boarding, grooming, Pet Play, and are home to Dog Wizard Canine Training Center.

Registration

Owner's First Name*

Owner's Last Name*

Spouse/Other First Name

Spouse/Other Last Name

Address*

Street Address

Address Line 2

City

State

ZIP Code

Phone*

Email*

SSN

Driver License #

Place of Employment

NO CHECKS WILL BE ACCEPTED WITHOUT THE SSN AND DRIVER’S LICENSE #

Pet Health History

Pet's Name*

Age / DOB*

Species*

Dog

Cat

Other

Breed*

Sex*

Male

Neutered Male

Female

Spayed Female

Color*

Any serious illness, surgeries, reaction to vaccines, allergies to medications?*

Yes

If yes, please explain*

Does your pet have insurance?*

Yes

If yes, please state the name of the insurance*

Name of Hospital that last vaccinated/treated your pet(s)*

Phone Number*

Would you like to add a second pet?*

Yes

Second Pet Information

Pet's Name*

Age / DOB*

Species*

Cat

Dog

Other

Breed*

Sex*

Male

Neutered Male

Female

Spayed Female

Color*

Any serious illness, surgeries, reaction to vaccines, allergies to medication?*

Yes

If yes, please explain*

Would you like to add a third pet?*

Yes

Third Pet Information

Pet's Name*

Age / DOB*

Species*

Dog

Cat

Other

Breed*

Sex*

Male

Neutered Male

Female

Spayed Female

Color*

Any serious illness, surgeries, reaction to vaccines, allergies to medications?*

Yes

If yes, please explain*

Authorization

I hereby authorize the veterinarian to examine, prescribe for or treat my pet(s). I assume responsibility for
all charges incurred to the care of my animals. I understand that these charges must be paid at the time of
release and a deposit may be required for surgical treatment.

Signature*

Date*

MM slash DD slash YYYY

Preferred method of payment*

Cash

Check

MasterCard

Visa

Discovery

American Express

Care-Credit

This field is for validation purposes and should be left unchanged.