New Patient Start

Date

Owner's Name *

First

Last *

Last

Email *

Preferred Phone *

Back-up Phone #

How did you hear about TLC Pet Hospital? Choose any that apply.

Other? If a friend referred you, let us know who.

Would you like for us to request records from your previous vet?

Yes

No

Address - Street, Apartment #, City, Zip *

PATIENT INFO:

Pet's Name *

Breed

Age

Color

Gender

Male

Female

History

Spayed

Neutered

Any details or medical history you would like us to be aware of?

We strive to make you a part of your pet's health care and understand you would like to be present for treatments. However, some treatments require restraint or special attention. For your safety, these treatments must be done back in our hospital area.

All fees must be paid at time services are rendered. WE DO NOT OFFER PAYMENT PLANS. We have the following financing options available. Deposits are REQUIRED for all hospitalized pets. I understand that any collection or legal fees incurred will be paid by me and all accounts over 30 days will be charged 18% interest.

Name of person responsible for authorizing an PAYING for services: *

Authorizations - I understand checking these boxes acts as my signature and authorization

I have read the above and understand and accept my financial obligation.

Social Media, I authorize use of my pet's image on social media and web media.

Captcha

Once you hit submit, you will be redirected to our Appointment Scheduling page. If you have not already scheduled an appointment, please complete the appointment request. We may not be able to accommodate you immediately without a scheduled appointment.

Welcome New Patients

New Patient Registration