Owner's Name*

First Last

Email*

Primary Phone*

Secondary Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Who else is authorized to make decisions about your pet's healthcare?*

First Last

Alternate Contact Phone*

How did you hear of our hospital?

Whom may we thank and please explain.

Pet's Name*

Species*

Cat
Dog

Pet Breed*

Pet Birthday/Age*

Pet Color

Sex*

Male
Male (Neutered)
Female
Female (Spayed)

Does Wellhaven Pethealth of Cedar Hills have permission to post your pets to our social media?

Yes
No

Does your pet have a microchip identification?*

No
Yes

Previous Veterinary Hospital

Previous Veterinary Hospital Phone Number

Payment is due in full at the time that services are performed. If being admitted into the hospital, we cannot begin the care of your Pet until you have confirmed your desire to do so by 1) signing the client consent & estimate form, and 2) leaving an initial deposit of 50% of the upper end of the estimate. This is the only way that we have of knowing for certain that you want us to proceed with the care of your Pet. We accept Cash, Visa, MasterCard, Discover, and CareCredit payments. We neither extend credit, nor bill for services. All open invoices are sent to collections after 45 days unless prior arrangements are made.*

I have read and accept the financial policy.

Name

This field is for validation purposes and should be left unchanged.

New Client Information Form

WellHaven Pet Health Cedar Hills
3370 SW Cedar Hills Blvd
Beaverton, OR 97005
503-828-9818

New Client Information Form

WellHaven Pet Health Cedar Hills3370 SW Cedar Hills BlvdBeaverton, OR 97005503-828-9818

WellHaven Pet Health Cedar Hills
3370 SW Cedar Hills Blvd
Beaverton, OR 97005
503-828-9818