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Acacia - New Client Form

New Client Welcome Sheet
Welcome to Acacia Animal Hospital.
So we may provide you with exceptional service,
please share information about you and your pet(s) with us.
Client Information
This question requires a valid email address.
How Did You Hear About Us
Patient Information
Does your pet have any allergies, special medications, or health problems that we should be informed about?
Previous Veterinarian
I hereby authorize the veterinarian to examine, prescribe for, or treat the above mentioned pet(s). I assume the responsibility for all charges incurred in the care of the animal. I also understand that these charges will be paid at the time of the patient’s release and that a deposit may be required for surgical treatment.
Signature of
For your convenience, we accept cash, check, MasterCard, Visa, Discover, and American Express.