Welcome to WVC. Thank you for giving us the opportunity to care for your pet. We will be happy to answer any questions you may have about your pet’s health. Here at WVC our mission is to provide your best friend with our very best loving, compassionate veterinary health and wellness care from before hello to beyond good-bye. To ensure the best care possible, please take the time to fill out this formOwner / Dueno* First Last Address / Direccion* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Emergency Phone*Spouse or Co-Owner's NamePhoneReferred ByEmail (only for the clinic purposes) Do you give us permission to put your pet’s pictures on our Facebook?YesNoPet #1NameMicrochip #Birth DateCat or Dog?SexBreedColorSpayed / Neutered?Last Date VaccinationLast Date RabiesWhere shots obtained?Allergies / Long term problems?MedicationsPet #2NameMicrochip #Birth DateCat or Dog?SexBreedColorSpayed / Neutered?Last Date VaccinationLast Date RabiesWhere shots obtained?Allergies / Long term problems?MedicationsReason for call?* Exam Diarrhea Coughing Sneezing Eating Problem Vomiting Other I hereby authorize the veterinarian and his/her assistants to examine, prescribe for, or treat, the above described pet (s). I assume responsibility forall charges incurred inthe care of this animal.The nature of such services has been described to me, to my satisfaction, and while I expect all procedures to be done to thebest abilities of the professional staff. I realize that there is no guarantee or warranty that can be ethically or professionally made regarding the results or cure. I understand that I will not receive a refund on any type of medication/and or vitamins. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment.I understand that Westwood Veterinary Clinicmaybe not present overnight; only during office hours.Date* Date Format: MM slash DD slash YYYY Signature*CAPTCHAEmailThis field is for validation purposes and should be left unchanged.