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Client Information Form

OWNER INFORMATION (Must be at least 18 years old.)

Client Name *

First

Last

Pronouns

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Best Contact Phone Number

Alternate Phone

Email Address *

How do you prefer to be contacted? Please select one *

Call
Text
Email

CO-OWNER INFORMATION

Name

First

Last

Pronouns

Best Contact Phone Number

Alternate Phone

Email Address

PET DESCRIPTION

Pet's Name: *

Date of birth / age (please approximate if not known)

Breed

Color

Sex *

Intact Male
Intact Female
Spayed Female
Neutered Male

Would you like to add information for a second pet? *

Yes
No

Pet's Name: *

Date of birth / age (please approximate if not known)

Breed

Color

Sex *

Intact Male
Intact Female
Spayed Female
Neutered Male

Would you like to add information for a third pet? *

Yes
No

Pet's Name: *

Date of birth / age (please approximate if not known)

Breed

Color

Sex *

Intact Male
Intact Female
Spayed Female
Neutered Male

Would you like to add information for a fourth pet? *

Yes
No

Pet's Name: *

Date of birth / age (please approximate if not known)

Breed

Color

Sex *

Intact Male
Intact Female
Spayed Female
Neutered Male

Would you like to add information for a fifth pet? *

Yes
No

Pet's Name: *

Date of birth / age (please approximate if not known)

Breed

Color

Sex *

Intact Male
Intact Female
Spayed Female
Neutered Male

MEDICAL RECORD RELEASE

We require authorization to release any information about your pet(s) medical history (including vaccine information). Please mark one of the following: *

I authorize the release of my pet(s) medical records to any veterinarian, daycare facility, boarding facility, or groomer requesting them and authorize them to be verified over the phone, copied, faxed, mailed, or emailed to the person or facility requesting them.
I DO NOT authorize the release of my pet(s) medical records to any veterinarian, daycare facility, boarding facility, or groomer requesting them without contacting me first for verification.

PHOTO RELEASE WAIVER

Please mark one of the following: *

I authorize Raintree Animal Hospital to use my likeness or my pet(s) in a photograph, video, or other digital media (“photo”) in any and all of its publications, including print publications, online publications, presentations, websites, and social media. Raintree Animal Hospital has my authorization to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.
I DO NOT authorize Raintree Animal Hospital to use my likeness or my pet(s) in a photograph, video, or other digital media (“photo”) in any and all of its publications, including print publications, online publications, presentations, websites, and social media.

PAYMENT POLICY

We accept the following forms of payment: Visa, Mastercard, American Express, Discover, CareCredit or Cash. We are no longer accepting personal checks at this location. We do not offer payment plans. Payment is due in full at the time service is provided. *

I have read the payment policy and agree.

Owner's Signature *

Date *

Email

Trust, Convenience, and Value

At Raintree Animal Hospital, we respect your bond with your pet, and we are dedicated to meeting your needs and concerns while providing the highest quality care for your pet—from birth through their senior years.

Contact

Phone: (970) 482-1987 (Call or Text)
Fax: (970) 482-6775
Email: raintree@raintreepets.com

Hours

Mon – Fri: 7:30 am to 5:00 pm
Sat – Sun: Closed

Online Store

Shop online for all of your pet’s needs and have it delivered right to your door.
Click here to shop now.

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