Owner’s Name: *

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone: *

Secondary Phone:

Email: *

Pet’s Name: *

Age/Date of Birth: *

Species: *

Dog
Cat
Other

Sex: *

Neutered
Unneutered
Spayed
Unspayed

Breed:

Color(s):

What is the reason for this visit? *

Signature *

Clear Signature

What is the best time to call about your pet? *

Has your pet been treated for any illness in the past year? *

No
Yes

Specify problem(s)/medications/ dosage:

Previous Veterinarian(s) where past medical records can be obtained if necessary:

Social Media Release: I am authorizing Oaklawn/Cranston Animal Hospital to post my pet’s picture, story and/or their medical information on the social media platform of their choice. *

Yes
No

Financial Policy:

Thank you for choosing Cranston Animal Hospital. Our primary mission is to deliver the best and most comprehensive veterinary care available for your pet. An important part of the mission is making the cost of optimal care as easy and manageable for our clients as possible by offering several payment options. Cranston Animal Hospital requires payment in full at the end of your pet’s examination and/or at the time of discharge

Payment Options:

Cash, Check, Visa, MasterCard, American Express, Discover Card

Convenient Monthly Payment Plans with CareCredit

Care Credit is a credit card that allows you to begin treatment today and pay over time.

Subject to credit approval

Available for any treatment amount

Can be used for your entire family without having to reapply

Additional Policy Information:

Cranston Animal Hospital charges $40.00 for missed appointments or same-day cancellations (subject to change). Please call us more than 48 hours in advance to cancel or reschedule your appointment.

Cranston Animal Hospital requires a non-refundable $100.00 deposit for surgical procedures. Please call 48 hours in advance to cancel or reschedule your appointment. This deposit will be applied to the final surgical procedure if completed. If a client does not drop off the pet on the day of surgery, the deposit will be processed as a payment.

Cranston Animal Hospital charges $30.00 for returned checks (subject to change).

Cranston Animal Hospital will inactivate all accounts that have been unpaid for more than 90 days. For an inactivated client to continue their relationship with the Hospital, they will need to pay the account balance before scheduling any appointments, requesting a doctor's callback, or buying medication. We offer payment plans, with approval from management, before referral (Subject to change).

For clients with pet insurance, we are happy to provide the necessary documentation to submit a claim to their insurance carrier.

If you have any questions, please do not hesitate to ask. We are here to provide your pet with the best veterinary care.

I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment.

Signature of Owner or Responsible Party: *

Clear Signature

Date *

New Client Registration Form