New Patient Registration Form

Save time at your next appointment! Please complete your required New Patient Registration form online from any device at any time before your visit.

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New Patient Registration Form

Please complete this form completely and accurately so that we can get to know you and your pet(s) before your visit. If this is an emergency or your pet requires immediate attention, please call us at 817-460-4441 for a faster response.

Name *

First

Last

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Secondary Phone

Additional Number

Fax Number

Email *

Driver’s License:

State *

Number *

Expiration Date *

Name of Employer *

Referred To Us By: (Phone Book, Drive by, Friend, Etc.) *

Spouse/Partner’s Name:

Phone Number

Email Address

List All Pets You Currently Own

Pet's Name *

Species (Dog, Cat, Bird, Rabbit, Other) *

Breed *

Sex *

Male
Female

Color *

Age/Date of Birth *

If birthdate unknown – approximate age *

Spayed / Neutered: *

Would you like to add another pet? *

Pet's Name *

Species (Dog, Cat, Bird, Rabbit, Other) *

Breed *

Sex *

Male
Female

Color *

Age/Date of Birth *

If birthdate unknown – approximate age *

Spayed / Neutered: *

Our policy is payment due at time of service. We accept cash, checks, Mastercard, Visa, Discover, American Express, and we offer Care Credit Financing. Release Form: I hereby consent and authorize the veterinarians/authorized agents at Sanford Oaks Animal Clinic to receive, prescribe for, treat and/or operate on my pets. I also agree to pay at the time of services and am aware that any unpaid debts can be turned into a collection agency and which will be subject to their fees. I have read the foregoing and agree.

Owner Or Authorized Agent's Signature *

Clear Signature

Date *

Name

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We have been proudly serving the pets of Arlington… since 1974. We’re here when you need us, whether for a routine checkup, a much-needed vaccination, or even surgery.

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