Forms

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Submit Our Forms Electronically

At Circle of Life Animal Hospital, we are now happy to offer an electronic form for new clients to make your pet’s first visit even more convenient! This feature enables you to complete your paperwork prior to your visit at our animal hospital. We encourage you to contact us if you have any questions about the New Client Form.

Please complete the information below and be sure to click ‘submit’ upon completion.

New Client Form


Client Name *


Spouse/ Co-Owner*


Address *

What is the best way to contact you?*

Pet Information

Sex*

Where can we request your pet's medical records?

May we send your pets' records to other veterinary hospitals, or grooming/boarding facilities if requested by the facility?

Professional Fees Are Due At The Time Services Are Rendered.

How did you hear about us?*

Please tell us who referred you or where on the internet you found us! Otherwise, type "N/A".

Can we use your picture on social media and in our marketing?*
Can we use your pets' pictures on social media and in our marketing?*
Authorization and Payment Information - Please read and initial each item stating that you agree.
By signing this form, you authorize Circle of Life Animal hospital to exam your pet and understand that we will provide an estimate for any services/treatment beyond the exam.
Payment is due at the time of service. We accept Visa/Mastercard/Amex/Discover/Cash/Care Credit/Scratchpay.
Circle of Life Animal Hospital understands that an unexpected illness may create financial hardship, and
arrangements can be made through Care Credit and/or Scratchpay. It only takes 5 minutes to apply.
We do not offer in-house payment arrangements.

Medical Work Up Inquiries for Drop Offs

Owner Name

Date

Pet Name

What problems are your pet experiencing?

When did the problem start?

Is the problem the same, better or worse?

Are there any medications being administered?

If yes, then what is the milligram strength and how often are you administering it? i.e "one and a half tablet of 300mg Gabapentin twice a day, at breakfast and then before bed."

What is your pet's current diet and feeding schedule?

Eating Changes?

Comments

Any changes in water consumption?

Comments

Any change in bowel movement?

Comments

Any vomiting?

Comments

Do you need any medication or food?

Audio/Photo/Video Release Form

Owner Name

Pet's Name

I permit Circle of Life Animal Hospital to record, own, publish and republish information about my pets for educational, marketing, and publicity purposes such as but not limited to their website and social media accounts.

I acknowledge that the pictures or recordings taken on this date and at any point after then become the sole and exclusive property of Circle of Life Animal Hospital.

I release Circle of Life Animal Hospital from any and all claims that might arise from the use of these images and/or recordings.

I, the undersigned, have read and fully understood the terms and conditions of signing this photo release waiver.
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