Garrettsville Animal Hospital

Thank you for choosing Garrettsville Animal Hospital for your pet's needs. Payment is expected at the time service is rendered.

We are pleased to accept the following forms of payment: CASH CHECK VISA M/C DISCOVER and CARE CREDIT

Please bring any health records you have for your pet to your first appointment. We look forward to meeting you and your pet and welcoming you to Garrettsville Animal Hospital. Should you have any questions prior to your first visit, please call us and we would be happy to answer them for you.

By filling out the following form, we will be able to provide better service to you and your pet. Should you have an appointment for more than one pet on your first visit, please fill out a "New Patient" form for each of them. Thank you!

Form - New Client Form

Primary Account Name (required)
First Name (required)	Last Name (required)

Secondary Account Name
First Name	Last Name

Address (required)
Street Address (required)


City (required)	State/Province (required)	Zip/Postal Code (required)
,

Daytime Phone (required)
Phone Type	Phone Number (required)

Evening Phone (required)
Phone Type	Phone Number (required)

Other Information

OH Driver License or State ID # (required)

E-Mail Address (required) :

Person authorized to order treatment in an emergengy
First Name	Last Name

Phone of Authorized Person
Phone Type	Phone Number

Whom may we Thank for referring you? (required)
(Please Choose One)
Newspaper
Yellow
Pages
Location
Sign
Website
Dr.Referral
Friend/Relative
Other

About Your Pet (for additional pets please fill out a New Patient Form)

Pet's Name (required)

Species (required)
Canine
Feline
Other

Sex (required)
Male Intact
Male Neutered
Female Intact
Female Spayed

Color :

Breed

Date of Birth

Is this pet current on vaccines, including Rabies? (required)
yes
no

Name of Previous Veterinary Practice

Phone of Previous Veterinary Practice

May we request health records? (required)
yes
no

The verification code below ensures the form is not submitted by a computer

Verification Code :

Enter the code you see in the graphic below in this box.
Your post will not be allowed if you do not type this in correctly.

Garrettsville Animal Hospital
8331 Windham Street
Garrettsville, OH 44231
(330)527-0722