Client Information Update Form

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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

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Ownership*


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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*

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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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