Online Registration

New Client Registration Online

Dr. Kafai Veterinary Hospital (24 Hours Open)

Client Registration And Consent Form For Vaccination, Hospitalization, Treatment, & Other Services. (Valid ID cards must be presented at registration. You must be 18 years of age or older)

All field with asterisk are mandatory( * )

Owner's Info

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First Name(*)

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Last Name(*)

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Address(*)

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Apt #

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City(*)

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Postal Code(*)

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Cell phone

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Home Phone

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E-mail address(*)

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In case of an Emergency, whom shall we call

Name(*)

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Relation(*)

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Phone(*)

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Patient's Info

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Pet’s Name(*)

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Breed(*)

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Species(*)

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Sex(*)

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Color(*)

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Birth Date / Estimate age (*)

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Last Vaccine Date(*)

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Does your pet(s) have any medical conditions, drug ,or vaccination reactions or other health issues of which we should be aware of ?

Describe /Comment(*)

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Does your pet(s) have any Pet Health Insurance(*)

Yes

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* To prevent the spread of infectious diseases and parasites, hospitalized animals must be current on all vaccines and free of internal and external parasites.

* For the safety of all pets and people, please keep your pet restrained by leash or carrier at all times.

I agreed(*)

Yes

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Security(*)

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