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New Client Registration Form

Thank you for considering our clinic 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. The below form must be completed before we can accept a new client.

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
  • I hereby authorize Benicia Cat Clinic to examine, prescribe for, and treat my pet(s). I agree to pay fees for services rendered at the time my pet is discahrged from the hospital or when service is otherwise terminated.
    I understand that veterinary service/care is provided after hours as necessary in the judgement of the veterinarian in charge, however, the continuous presence of qualified personnel is not provided.
    I also understand that all medical records at this clinic, including radiographs, pertaining to my pets) belong to and are the property of Benicia Cat Clinic. (Copies are available as needed upon request).
  • We accept: Discover, American Express, Care Credit