New Client Form

Name

First Last

Address

Street Address Address Line 2 City ZIP / Postal Code

Phone*

Work Phone

Cell Phone

Email

Do you consent to receive reminders and other information pertinent to your pet via e-mail?

Yes
No

How would you prefer to receive reminders for your pet?

E-mail
Mail
Phone

How did you choose our hospital?

Location
SaskTel Yellow Pages
Internet
Personal Reference
Holistic medical care
Other

If you chose "Other" above

If 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 is needed the hospital recommends the use of Medicard to provide necessary financing.

If, in case of an emergency, we cannot get a hold of you, who is authorized to give permission for treatment?

Name #1

First Last

Phone #1

Name #2

First Last

Phone #2

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 check one option.

Please check one option for the above statement.

Yes
No

Yes, up to $

(ln most circumstances $600 will allow us to stabilize your pet until we are able to contact you or your representative)

Yes, unlimited amount

Please sign your name below if you would like this option.

No. Please sign here to authorize euthanasia

If 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.

Owner's Signature*

Date*

Contact Us

New Client Form

Hospital policy is that we do not offer payment plans. If financial help is needed the hospital recommends the use of Medicard to provide necessary financing.

If, in case of an 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 check one option.

If 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.

New Clients

Pet Health

Resources

New Client Form

Hospital policy is that we do not offer payment plans. If financial help is needed the hospital recommends the use of Medicard to provide necessary financing.

If, in case of an 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 check one option.

If 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.

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New Clients

Pet Health

Resources