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

  • 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
  • St. Francis Animal Hospital is a full-service veterinary medical and surgical facility. We have business and medical staffing hours as follows: Monday-Friday 8:00 am to 6:00 pm Closed on Saturdays/Sundays and Holidays Therefore this disclosure form is provided to inform you that we have NO in-house, on-duty continuous medical staff as follows: Overnight, from closing time at 6:00 pm to opening at 8:00 am. Holidays, falling on Monday, from to opening on Tuesday at 8:00 am. There is, however, a trained staff member who will be checking all hospitalized patients during the hours that the hospital is not fully staffed. That schedule is determined by the attending doctor and may vary with the needs of the individual patient. If you have any questions concerning this policy, please don't hesitate to ask. Also, if you would like continuous overnight care of your pet, discuss those options with the doctor or technician.
  • Date Format: MM slash DD slash YYYY