New Client Check In

Owner / Caregiver

Please provide the information below as completely as possible. All information is strictly confidential.

Pet Information

Referral Information

Statement Of Ownership

By checking below you certify that you are the owner and or agent of the above animal and have the authorization to consent to treatment if and when it is needed. 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 Safe Harbor Animal Hospital and that charges are due and payable at the time of service, unless other arrangements are made in advance. 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 Safe Harbor Animal Hospital's collection agency, and will incur a 25% collection fee for which I am liable, in addition to monthly finance charges.

Enter the verification code in the box below.