Welcome to the Hunter PetCare! Please take a few minutes to answer the following questions so that we may better serve you and care for your pet.

PET NAME(Required)

OWNER INFORMATION

Owner must be at least 18 years old. Please include co-owner if applicable

First Owner's Name(Required)

First Owner's Cell Phone(Required)

First Owner's Employer(Required)

First Owner's Work Phone(Required)

Second Owner's Name

Second Owner's Cell Phone

Second Owner's Employer

Second Owner's Work Phone

Address(Required)

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

How did you hear about us?(Required)

Friend/neighbor

Internet

Currently/formerly a client

Driving by

Please list Friend/neighbor's name

PAYMENT POLICIES

NO CHECKS ARE ACCEPTED AS PAYMENT. We accept Visa, Mastercard, Discover, American Express, Care Credit & Cash

A charge may be assessed for appointments canceled without 24 hours notice.

FULL PAYMENT IS EXPECTED AT TIME OF SERVICE.

We will gladly prepare a written estimate of service fees if you desire.

Any account deemed “difficult to collect” by management will be forwarded to a collection agency. All fees associated with the collection process (including but not limited to: agency fees, attorney fees and court costs) will be come the responsibility of the delinquent party. Unpaid charges will incur finance charges monthly until paid in full.

I acknowledge that I have read, understand and agree to the above listed payment policies. In addition, I agree that by accepting service and/or merchandise offered by Hunter PetCare, I am contracting to pay the full price of the service/item, less any discount extended to me by the hospital management. I hereby authorize All about PetCare, Inc. to release any medical information/records which they deem necessary to those I entrust with my pet’s wellness. I understand that medical records will not be released if there is an outstanding balance on my account. A release of medical records fee of up to $50 may apply.

Signature #1(Required)

Date(Required)

Signature #2

Date

PET INFORMATION

Name(Required)

Breed(Required)

Color(s)(Required)

Date of Birth or Age(Required)

Sex(Required)

Male

Female

Spayed or neutered(Required)

Yes

Has your pet ever been seen at our other location All About Pet Care?(Required)

Yes

Date this pet was last examined by a veterinarian(Required)

Where?(Required)

Please list any known allergies your pet has(Required)

Has this pet had any previous medical problems?(Required)

Yes

Please describe problems and treatment

Is this pet currently being treated for a medical condition or taking any medication?(Required)

Yes

Please list

ADDITIONAL TREATMENT AUTHORIZATION

Please list any other people authorized to approve treatment or receive information regarding your pet’s condition:

1) Name

1) Relationship to owner

1) Phone #

1) Please choose one of the following

Authorized to approve treatment and receive information regarding the pet’s condition in ALL situations (including emergencies, routine and sick appointments). The owner accepts financial responsibility of all treatments approved

Authorized to approve treatment and receive information regarding the pet’s condition in EMERGENCY situations only. The owner accepts financial responsibility of all treatments approved.

Authorized ONLY to receive information regarding the pet’s condition, NOT to approve treatment or bring the pet in on the owner’s behalf.

1) Authorized Signature

2) Name

2) Relationship to owner

2) Phone #

2) Please choose one of the following

Authorized to approve treatment and receive information regarding the pet’s condition in EMERGENCY situations only. The owner accepts financial responsibility of all treatments approved.

Authorized ONLY to receive information regarding the pet’s condition, NOT to approve treatment or bring the pet in on the owner’s behalf.

2) Authorized Signature

Thank you for choosing Hunter PetCare. We look forward to helping you keep your pet happy and healthy!

New Client Registration

OWNER INFORMATION

PAYMENT POLICIES

PET INFORMATION

ADDITIONAL TREATMENT AUTHORIZATION