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Craig Road Animal Hospital - New Client Registration

For Office Use

Name (last, first m.i.)___________________________________________________________

 
Home Phone __________________ Work Phone __________________ Cell Phone ____________________

Employer __________________________ Address ______________________________________________

AUTHORIZATION - !/We hereby authorize the veterinarian to examine, prescribe for, or treat my pet(s).  I/We assume full responsibility for all charges incurred in the care of this/these animals.  I/We also understand that these charges will be paid in full at the time of release and that a deposit may be required for certain surgical treatments or other procedures.

Signature of Owner _____________________________________________________________ Date _______

Signature of Spouse/Co-owner ____________________________________________________ Date _______