New Client Registration Name First Last Address Street Address Address Line 2 City State Zip Code Email Primary PhoneHome PhoneWork PhoneHow did you hear about us? Sign Recommendation Who recommended you? Pet Registration1st PET INFORMATIONPet Name Species Dog Cat Reptile Exotic Breed Color Date of Birth MM slash DD slash YYYY If unknown, approximate age: Sex Male Female Spayed/Neutered? Yes No Is your pet up to date on vaccines? Yes No Please list prior illnesses, surgeries, or allergies:Is your pet currently on any medications? Yes No Names and dosage:2nd PET INFORMATIONPet Name Species Dog Cat Reptile Exotic Breed Color Date of Birth MM slash DD slash YYYY If unknown, approximate age: Sex Male Female Spayed/Neutered? Yes No Is your pet up to date on vaccines? Yes No Please list prior illnesses, surgeries, or allergies:Is your pet currently on any medications? Yes No Names and dosage:Photo Consent I hereby grant New Light Animal Hospital permission to take photographs of my pet(s), and to publish those photographs for any lawful purpose, including but not limited to their website, social media accounts, and promotional materials either digital or in print, in perpetuity. I understand that New Light Animal Hospital will not use my name.By electronically signing this form, I authorize New Light Animal Hospital to edit and share the photograph(s) mentioned above. I also waive any rights of privacy or compensation associated with the use of my pet(s) image(s) for the personal or commercial purposes outlined above.Thank you for choosing New Light Animal Hospital! Our primary mission is to provide compassionate care, affordable rates, and superior comprehensive veterinary care with a family approach. We diligently strive to ensure that the cost of quality veterinary care is as economical and manageable for our clients as possible by offering multiple payment options.We offer multiple payment options in the form of: Cash, Check, Visa, MasterCard, Discover, American Express, and Care Credit.**All returned checks will be charged an additional $35.00.****New Light Animal Hospital requires payment in FULL at the time of check out.**By signing below, you acknowledge and fully understand the New Light Animal Hospital financial policy and agree the New Light Animal Hospital terms of payment.Electronic Signature*