56 Tram Road, Clinton, NC 28328

New Client/Patient Registration Form

New Client / Patient Registration Form

Thank you for giving us the opportunity to care for your pet.
We’ll be happy to answer any questions you have about
your pet’s health.
To ensure the best care possible, please take the time to fill out this form completely. Thank you!

REGISTRATION

Owner's Name
Owner's Name
First Name
Last Name
Spouse Name
Spouse Name
First Name
Last Name
Address
Address
City
State/Province
Zip/Postal
How did you find out about our practice?

Pet Health

Sex
Is your pet spayed / neutered?

Authorization

We love social media! Do we have your permission to share your pet(s)’ image(s) and story on social
media, our website and other forms of related media?
Your name and personal information will never be shared unless you
allow.
Simply check below to authorize this:
Photo Consent
I hereby authorize the veterinarian(s) to examine, prescribe for and/or treat the above described pet(s).
I assume responsibility for all charges incurred in the care of this animal.
I understand that payment is always due IN FULL at the time of service.
Our staff is always happy to provide estimates.
Method of Payment
**WE DO NOT ACCEPT PERSONAL CHECKS** ONLY CASH, VISA, MASTERCARD or DEBIT

Tram Road Animal Hospital * 56 Tram Road * Clinton, NC 28328 * 910-592-3102 * www.tramroadah.com