Client Information Update Form

"*" indicates required fields

We are honored that you have chosen us to take care of your beloved pet. Please fill out the form below to update our client database information. (Note: this form is for current active clients only, if you are a new client, please visit this link

Client Information

What are your preferred pronouns?*




Ownership*


Is this number for



Communication Preference*



Address*















Do you have pet insurance?*


Authorization

Photo Release – I authorize Health & Harmony Animal Hospital to take photographs of my pet and to copyright, use and publish them in print and/or electronically. This could include purposes such as social media, website and newsletters. My name will not be used but my pet’s name may or may not be included.*


Records Release – I authorize the release of my pet’s medical records to another facility (boarding/daycare/emergency hospital, etc) should they be requested.*


Authorization – I hereby authorize the veterinarian to examine, prescribe for and treat the above described pet(s). I assume responsibility for all charges incurred in the care of this animal and certify that I am the rightful owner of the above listed animal(s).
Consent*
Consent*


MM slash DD slash YYYY

This field is for validation purposes and should be left unchanged.







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  • 1

    Call us or schedule an appointment online.

  • 2

    Meet with a doctor for an initial exam.

  • 3

    Put a plan together for your pet.

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