White Oak Animal Hospital
New Client Registration

In case of EMERGENCY

List the names and types of any other animals that you own:

How did you first hear of us?

Are there any personal issues you would like us to be aware of? (i.e. allergies, claustrophobia, fear of animals) :

I assume responsiblity for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment.

If this account becomes delinquent, I hereby agree to pay 33 1/3% attorney fees and all other costs to collect this debt.

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