(925) 448-2908

Our Walnut Creek, CA Office

Walnut Creek Veterinary Hospital

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New Client Registration Form

  • PRIMARY OWNER INFORMATION

  • MM slash DD slash YYYY
    (required for prescriptions)
  • SECONDARY OWNER/CONTACT INFORMATION

  • (if different from primary)
  • First Pet

  • BreedSexDate of BirthColor
  • Second Pet

  • BreedSexDate of BirthColor
  • Third Pet

  • BreedSexDate of BirthColor
  • Payment is required for all services when they are rendered unless prior arrangements have been made with hospital management. We accept cash, check, VISA or MASTERCARD and only take payments over the phone with prior approval. All returned checks are subject to a $35.00 service fee. Any account past due by 90 days is subject to collections and a $35.00 collection fee. Your signature below signifies your understanding and willingness to comply with hospital payment terms. In some cases, a deposit may be required before proceeding.

    Veterinary Consent: I, the undersigned owner or owner's agent of the pet(s) identified, certify that I am over 18 years of age. I authorize Walnut Creek Veterinary Hospital to perform the treatment(s)/procedure(s) described in my pet's medical chart. I will be informed of the reasons for the treatment(s)/procedure(s), along with expected benefits and risks involved. I understand that unforeseen conditions may require an extension of planned treatment(s)/procedure(s). I hereby authorize the performance of such treatment(s)/procedure(s) as are necessary and advisable in the professional judgment of Dr. Jill Christofferson and or an Associate Veterinarian. I understand that I assume all risks and am responsible for all costs incurred.

  • MM slash DD slash YYYY
Walnut Creek Veterinary Hospital

Location

540 Lennon Lane
Walnut Creek, CA 94598

Phone: (925) 448-2908

Office Hours

Monday – Friday: 8:00am to 6:00pm
By Appointment Only

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