New Client Registration Form

Name

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Address

Street Address Address Line 2 City State Zip Code

Primary Phone

Home Phone

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Primary Phone

Home Phone

Work Phone

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Thank you for choosing Wake Vet Hospital & Urgent Care! 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.**

Any necessary treatments and/or hospitalized care will be provided an estimate.

**Wake Vet Hospital & Urgent Care requires payment in FULL at the time of check out.**

By signing below, you acknowledge and fully understand the Wake Vet Hospital & Urgent Care financial policy and agree the Wake Vet Hospital & Urgent Care terms of payment.

Electronic Signature(Required)

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Pet Registration

1st PET INFORMATION

Pet Name

Species

Dog

Cat

Reptile

Exotic

Breed

Color

Date of Birth

If unknown, approximate age:

Sex

Male

Female

Spayed/Neutered?

Yes

Is your pet up to date on vaccines?

Yes

Please list prior illnesses, surgeries, or allergies:

Is your pet currently on any medications?

Yes

Names and dosage:

2nd PET INFORMATION

Pet Name

Species

Dog

Cat

Reptile

Exotic

Breed

Color

Date of Birth

If unknown, approximate age:

Sex

Male

Female

Spayed/Neutered?

Yes

Is your pet up to date on vaccines?

Yes

Please list prior illnesses, surgeries, or allergies:

Is your pet currently on any medications?

Yes

Names and dosage:

Photo Consent

I hereby grant Wake Vet Hospital & Urgent Care 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 Wake Vet Hospital & Urgent Care will not use my name or my pet's name.

By electronically signing this form I authorize Wake Vet Hospital & Urgent Care 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.

Electronic Signature(Required)

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Pet Registration

Wake Veterinary Medical Center

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