New Pet Information

Owner Name

Pet Information

MM slash DD slash YYYY

Medical History

Example: 07/2022
Vaccinations received (please check all appropriate):
Is your pet on heartworm preventative?
If so, which?

MM slash DD slash YYYY
MM slash DD slash YYYY
Does your pet have a microchip?

Other Pets in the Household


Pet Photo Release

Photo Release Authorization
I grant to Creekside Animal Hospital, its representatives and employees, the right to take photographs of my pet(s), and to copyright, use and publish the same in print and/or electronically. I agree that Creekside Animal Hospital may use such photographs of my pet(s) with or without their name, or mine, and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content.