Name *

First

Last

Date *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone *

Home Phone

Spouse

First

Last

Spouse Cell

Pet's Name *

Species *

Dog
Cat

Breed *

Color *

Sex *

Male
Male (neutered)
Female
Female (spayed)

Age/Date of Birth *

Do you give Arch Animal Hospital Permission to release medical records to other veterinary facilities, groomers, or boarding facilities if requested? *

I agree (yes)
I disagree (no)

How were you referred to Arch Animal Hospital

Let us know who, so we can thank them:

If other, please specify.

SMS Disclosure: By providing your phone number and opting into our SMS program, you agree to receive promotional, transactional, text messages from Richards Veterinary Services DBD Arch Animal Hospital Main. *

I Agree and Understand

Privacy Policy: Your privacy is important to us. Please review our Privacy Policy to understand how your information is used and protected.

Signature *

Clear Signature

I understand that fees are payable at the time of services rendered unless prior arrangements have been made and the proper forms have been completed.

I grant Arch Animal Hospital, its representatives and employees the right to take photographs of me and/or my pet, and to copyright, use and publish the same in print and/or electronically. I agree that Arch Animal Hospital may use such photographs of me and/or my pet with or without my name and for any lawful purpose, including, for example,such purposes as publicity, illustration, advertising, and Web content. *

The above may take photos of me and/or my pet
The above may NOT take photos of me and/or my pet

New Client Form

New Client Form

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Address

Visit our sister location Arch Animal Hospital West

Hours

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