New Client Registration Form New Client RegistrationPlease enable JavaScript in your browser to complete this form.Client Name *Phone NumberEmail: *Address: *Date of Birth *Drivers License / State ID Number: *How did you hear about us?As Fear Free Certified Professionals we use peanut butter and other foods to help make your pet at ease. Please indicate if you, or anyone in contact with your pet has a peanut or other food allergy. *I have, or someone in contact with my pet has a food/peanut allergy.There is no one with a food/peanut allergy in contact with my pet.Pet Name *Species *FelineCanineAge/Date of Birth *BreedColorMicrochipSex *FemaleMaleSpayed/Neutered *YesNoUnsureDo you have another pet to add? *YesNoPet Name (2) *Species (2) *FelineCanineAge/Date of Birth (2) *Breed (2)Color (2)Microchip (2)Sex (2) *FemaleMaleSpayed/Neutered (2) *YesNoUnsureAny reactions to medications or vaccines?Any additional information you would like us to know?Previous VetI, the undersigned, do hereby grant permission to Hope Veterinary Care, LLC, to post my and/or my pet’s story, photo, or other item, hereinafter referred to as “Materials” to Hope Veterinary Care’s website, Twitter account, Facebook account, and Instagram account. I hereby release Hope Veterinary Care, your representative, employees, managers, and owner from all claims and demands arising out of or, in connection with, any use of said “Materials” including, without limitation, all claims for invasion of privacy, infringement of my right of publicity, defamation and another other personal and/or property right. I acknowledge and agree that no sums whatsoever will be due to me as a result of the use of the “Materials” or any rights.I, to the best of my knowledge, have filled out this form in its entirety and believe it to be accurate and true. *NameSubmit
