WELCOME to Animal Kingdom Veterinary Hospital. Thank you for giving us the opportunity to care for your pet(s). Please take a moment to complete this form so we can help you and your furry family’s needs. **Flip over for additional pet information**Date MM slash DD slash YYYY Owner: Spouse/Other: Address Street Address City State / Province / Region ZIP / Postal Code Primary PhoneSecondary PhoneEmail Emergency Contact Name and Number: How did you hear about Animal Kingdom? Do you prefer: Conventional Holistic Conventional and Holistic Pet InformationName Date of Birth MM slash DD slash YYYY Select that apply Dog Cat Female Male Spayed Neutered Intact Breed: Color Tell us about your pet’s diet, including raw, homemade, and treats.Tell us about your pet’s current medications: Include supplements and vitamins:Did you bring vaccine history, medical records, or radiographs? Yes No Previous hospital name and number for records: I hereby authorize the veterinarians to examine, prescribe for, or treat the described animal(s) on this form. I assume the responsibility for all charges incurred in the care of the animal(s). I also understand all charges will be paid at the time of each release and that a deposit will be required for any surgery, treatment, or hospitalization.Signature of OwnerDate MM slash DD slash YYYY Method of pay: Visa Mastercard Discover Amex Cash Check *check payments must be in state and require a copy of your driver’s license* *we do not offer payment plans*Additional Pet InformationPet’s Name: Date of Birth: MM slash DD slash YYYY Circle all that apply: Dog Cat Female Male Spayed Neutered Intact Breed: Color: Tell us about your pet’s diet, including raw, homemade, and treats.Tell us about your pet’s current medications: Include supplements and vitamins:Did you bring vaccine history, medical records, or radiographs? Yes No Previous hospital name and number for records: Pet’s Name: Date of Birth: MM slash DD slash YYYY Circle all that apply: Dog Cat Female Male Spayed Neutered Intact Breed: Color: Tell us about your pet’s diet, including raw, homemade, and treats.Tell us about your pet’s current medications: Include supplements and vitamins:Did you bring vaccine history, medical records, or radiographs? Yes No Previous hospital name and number for records: