New Client Form

Thank you for visiting our hospital. We look forward to getting to know you and your pet. Please help us to provide the best care possible for your pet by taking a moment to fill out this form. 

FOR ANY EMERGENCIES, PLEASE CALL OUR OFFICE IMMEDIATELY.


Client / Owner Information
Address
Pet Information
Your Visit
Would you like us to call you for your appointment?
Agreement

I understand, by indicating I agree and submitting this registration, that I am responsible for any charges incurred by my pet while in the care of the doctors at Rau Animal Hospital and that charges are due and payable at the time of service. Any balance that is carried over a period of 30 days will accrue a monthly finance charge of 1.5% or 18% per annum. Any balance that I leave unpaid will be forwarded to Rau Animal Hospital's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.

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