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Critter Care Animal Hospital Client Registration Form
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Email *
Today's Date: *
Owner's full name: *
Full Address (Street, City, State, Zip Code): *
Home Phone Number:
Cell Phone Number: *
Work Phone Number:
Name of Spouse & phone number:
Which number would you prefer to be listed as the primary contact number? *
In case of an emergency, please call: *
How did you learn about our facility? *
If you were referred, please name the individual or business so we may thank them.
Do we have your consent to post pictures of your pet(s) to our social media platforms? *
What company do you use for pet insurance?  *
My typed initials below indicate that I assume responsibility for all charges incurred in the care of my animal(s). I understand that these charges will be paid at the time of release or as services are rendered and that a deposit may be required for surgical treatment. I realize that for any appointments or scheduled procedures for which I do not show up with my pet and do not call to cancel, that I may be charged as much as the actual cost of the scheduled appointment or procedure. *
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