New Patient Form

Client / Owner Information
Your County
Referral Information
About Your First Pet
One file only.
100 MB limit.
Allowed types: gif, jpg, png, svg.
One file only.
100 MB limit.
Allowed types: gif, jpg, png, svg.
Who is your pet scheduled to see?
We will be recording your doctor appointments and using that information for your pet's exam notes.
Did you already send us medical records?
One file only.
100 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.
If you had your preference in communicating with our clinic (you can select up to 2), how would you like us to communicate with you?
Do you allow us to use pictures of your pet on our website, social media, and in the hospital?
I allow ORAH to use photos of my pet, and I know ORAH will not use my name or other identifying facts.
I do not want ORAH to use pictures of my pet for any purposes.
Do you allow us to release medical information about your pet when requested by another animal hospital, groomer, boarding or day care facility, an adoption agency or rescue organization?
I would like you to give information when requested.
I want to be contacted and authorize every request to release information.

I hereby authorize the veterinarian to examine, prescribe for or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges must be paid in full, at the time of release of the pet.

Sign above