New Patient Information

Patient's name required
Client / Owner Information
Name required
Enter phone number 
Enter cellphone number 
Enter work phone number
Email required
Enter address
Enter spouse/co-owner name
Enter spouse/co-owner phone
Enter spouse/co-owner work phone
Enter spouse/co-owner email
About Your First Pet
Enter first pet name
Select first pet type
Enter first pet breed
Enter first pet color
Select first pet sex
Select first pet spayed/neutered
Enter first pet age
Enter second pet name
Select second pet type
Enter second pet breed
Enter second pet color
Select second pet sex
Select second pet spayed/neutered
Enter second pet age
Previous Veterinary Clinic
Enter Previous Doctor's Name
Enter Previous Hospital Name
Enter City and State
Enter Doctor phone number
Marketing
Select how you heard about us
Photography Permission
I approve for my pet's photograph to be posted on Pleasant Ridge Pet Hospital and Cat Care Clinic's social media platforms

I hereby authorize the veterinarian to examine, prescribe for or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges must be paid in full, at the time of release of the pet.

Consent to Video and Audio Recording

I acknowledge that cameras may record my image while I'm inside the pet hospital for security purposes.

I acknowledge that during patient exams, audio recording is in place for medical note-taking.

We do not accept payment plans. We do accept Care Credit and Scratch Pay if financing is needed.

I acknowledge appointment cancellations are accepted up to 24 hours prior to your appointment time. A missed appointment fee will be applied to your account for same-day cancellations or no-shows.

I acknowledge deposits are required prior to scheduling surgeries. Surgery cancellations are accepted up to 48 hours prior to your scheduled date. Surgery deposits are forfeited for cancellations within the 48-hour time frame or for no-shows.

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