New Client Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Last Name *First Name *Address *Postal Code *Home Phone Number *Cell Number *Work Number *Email *Do you consent to receive reminders and other information pertinent to your pet via email? *YesNo until are thank? How would you prefer to receive reminders for your pet? *EmailMailPhoneHow did you choose our hospital? *LocationPersonal PreferenceSocial MediaGoogleHolistic Medical CareOtherIf personal reference, whom may we thank? *Name of your Pet Insurance Provider *Payment in full is due upon completion of services. What method of payment do you prefer? (Hospital policy is that we do not offer payment plans. If financial help needed the hospital recommends the use of Petcare to provide necessary financing.) *CashDebit CardVISA cardMastercardPetcardIf, in case of emergency, we cannot get a hold of you, who is authorized to give permission for treatment? *If we are unable to get a hold of you or your representative, is Arlington Animal Hospital authorized to provide emergency services (including CPR) for your pet at your cost? Please initial one option below. *Yes, you are authorized up to $________________(in most circumstances $600 will allow us to stabilize your pet until we are able to contact you or your representative)Yes, you are authorized for an unlimited amountNo, you are unauthorized to perform emergency services. Please sign in box below to authorize euthanasiaIf you choose not to decide on one option the staff at Arlington Animal Hospital will humanely end your pet's suffering if above situation should arise.Submit