REGISTRATION Owner * Spouse/Other * Home Phone * Work Phone * Cell Phone * has your registration information changed since you got this new pet? If you selected yes please fill out our updated registration information. * Email * Occupation * Employer * PET HEALTH HISTORY Name of Pet's * Sex * Spayed/Neutered * Breed * Age * Color * LAST VACCINATION DATES Dogs Distemper * Parvo * Bordatella * Rabies * Is your dog on a preventative heartworm medication? * CATS FVRCP * FELV * Rabies * ALPACAS: CD & T * Areas your pet has lived besides the Chino Valley/Prescott Area? * Problems we should be aware of: chronic illness, allergies, medications etc * We at Circle L Animal hospital strive to provide your pet(s) with uncompromising care, in a warm safe environment. Our regular office hours are by appointment: Monday to Friday 8:00am-6:00pm, closed Tues. from 12:00pm-1:30pm, and open Saturday from 8:30am-2:00pm. A doctor is available on call 24 hours, however we do not have an attendant on the premises 24 hours. Should you need a Doctors service after our regular office hours, call 771.7564 and the Doctor on call will be paged. If the Doctor is involved in another emergency, there may be a sight delay in getting back to you, but the Doctor will return your call! AUTHORIZATION
PAYMENT IS EXPECTED AT THE TIME OF SERVICES. Cash, Check, Visa, Mastercard, Amex, Discover and Care Credit are accepted. We provide quotes for routine services on request. In estimating costs for emergency services, we will keep you informed if any changes. In the event that an account is not paid full in due, it will bear interest at the rate of 24% per anum. Client further agrees to pay cost of collection and reasonable attorneys fees if this matter is referred an attorney for collection.
Drivers License # * Where did you hear about us? How did you hear about Circle L Animal Hospital * If you were referred by a friend/neighbor, please provide us with their name and telephone number below so that we can apply a $30:00 Client Referral Credit to their account. Learn more about our referral program below! Name Phone HAVE YOU HEARD ABOUT OUR REFERRAL PROGRAM?
Earn credit and help pay for your veterinary care. Tell a friend about us and encourage them to come in for a visit . All they need to do is present this "referral card" to us and upon completion and payment for their office visit you will be credited $30:00 towards products and service for your next visit to 4 Paws Rehabilitation.
New Client Name: Pets Name * I was referred by: Staff Initial