New Client Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk.
  • Owner's Name

  • Co-owner's Name & Contact #

  • Pet Information

  • Date Format: MM slash DD slash YYYY
  • Payment is expected in full when services are rendered. Accepted methods of payment are cash, checks, American Express, Discover, MasterCard, Visa, Scratchpay and Care Credit. Payment plans are NOT available. There will be a $50 fee for any returned checks and a 1.5% finance charge per month (18% APR) on outstanding balances. Should your account be placed for outside collections, you will be chared reasonable collection costs which may include but NOT limited to, collection agency fees, court costs, attorney fees, etc. **By submitting this form, I also grant St. Francis Animal Hospital permission to use my pet's picture and name on social media