Please complete this form before your first visit. We look forward to meeting you!
Please complete this form carefully and thoughtfully. All information is kept confidential and allows us to provide the best service for your pet needs.
Please allow us to verify/photocopy your driver's license, state-issued identification card, or military identification card. If you do not wish to provide this information, we require prepayment for all office visits, surgeries, procedures, and products. Your SSN/DL numbers are NOT entered into our software.
If you are a military service member, please write more than just “US Navy or US Airforce.” Please include your unit, building number, and military mailing address. This is to CONTACT you in the event other methods of contact have failed.
About your pet's privacy: We do not discuss your pet's case with any person who is not a veterinarian or veterinary staff without your permission. If there is anyone else permitted to pick up/drop off/or discuss your pet's disposition, please provide their information below.*
*You understand that the pet (s) listed here are your legal and financial responsibility regardless of who may be listed as an additional contact.
By signing below, I hereby authorize Northwood Hills Animal Hospital to examine, prescribe for, or if necessary, perform surgery upon my pet(s).