Client and Pet Registration Form

Client Information

Client Name

Spouse/Partner

Address

City

State

Zip

Home Phone

Mobile

Work

Email

Agent/Co-Owner Name

Address

City

State

Zip

Home Phone

Mobile

Who may we thank for referring you today?

Pet Information

Pet's Name

DOB/Age

Breed

Color

Sex

Spayed/Neutered

Referring Veterinarian/Primary Veterinarian

Clinic/Hospital Name

Doctor's Name

City

State

Medical History

Briefly, what is the reason for today’s visit?

Are there any diseases/conditions that your pet currently has or has had in the past? If yes, please list.

Is your pet currently taking any medications? (including vitamins, supplements etc.) If yes, please list.

Does your pet have allergies to medications, anesthetics, or foods? If yes, please list.

Tufts Veterinary Emergency Treatment & Specialties Agreement and Consent

  • I agree to pay for all services rendered to my pet at the end of today’s examination.
  • I understand that payment is required at the time of service.
  • I understand that the cost of the initial exam does not cover any further diagnostics, treatments, or medications that may be necessary for my pet.
  • I understand that if further diagnostics or treatments are recommended by the doctor I may request an estimate of those charges first.
  • I understand that I have the right to refuse any treatments, diagnostics, or medications that have been recommended to me by the doctor.

Owner/Agent Signature

Date

You and your doctor will be provided with a report from the doctor for every examination performed on your pet at Tufts VETS. Thank you for trusting us to care for your pet!