New Client Registration | West Seattle Animal Hospital

1. OK to send text reminders and updates?*

2. Co-Owner Name (first & last):

3. Co-Owner Phone Number:

Emergency Contact

4. Who should we contact in case of an emergency (other than you or your spouse/partner)?

5. Phone number for emergency contact

Patient Information:

6. Pet's Name*

7. Species*

8. Breed(s)*

9. Gender*

10. Primary Coat Color*

11. Secondary Coat Color

12. Coat Characteristics*

13. Date of Birth (approximate age ok)

14. Is your pet microchipped?*

15. If yes, microchip number (We can scan your pet once you arrive if you don't know the number)

Second Pet Info

16. Pet's Name

17. Species

18. Breed(s)

19. Gender

20. Primary Coat Color

21. Secondary Coat Color

22. Coat Characteristics

23. Date of Birth (approximate age ok)

24. Is your pet microchipped?

25. If yes, microchip number (We can scan your pet once you arrive if you don't know the number)

Third Pet Info

26. Pet's Name

27. Species

28. Breed(s)

29. Gender

30. Primary Coat Color

31. Secondary Coat Color

32. Coat Characteristics

33. Date of Birth (approximate age ok)

Yes No Unknown

34. Is your pet microchipped?

35. If yes, microchip number (We can scan your pet once you arrive if you don't know the number)

Appointment Options

36. This helps us match your registration to your appointment*

37. If you have an appointment already please enter the Date & Time you are scheduled for:

Referral Information

38. What is the name and city/state of your prior veterinary care office?

39. How did you hear about us? (Select all that apply)*

Our website

Location

Google

Other Internet search engine

Yelp

Friend, Neighbor or Family Member

Phone Book

Animal Shelter or Rescue Group

Coupon

Other

40. May we thank a specific person or business for referring you?

Payment and Fee Information

Payment is due in full at the time of service.
We do not provide billing services. Upon request, we will provide you with a written estimate for your pet's care. A deposit may be required before treatment. We accept cash, debit cards, Visa, Mastercard, American Express, Discover, and Care Credit. Checks may be accepted at our discretion. Returned checks will incur a service charge of $25. Unpaid accounts are assigned to a collection agency and may incur additional charges such as interest and legal fees.*