Redwood Pet Clinic

Client and Patient Registration Form – Other

First Name (required)

Last Name (required)

Middle Name

Spouses Name

Address (required)

City (required)

Zip Code (required)

Home Phone (required)

Work Phone

Cell Phone

Email Address

Drivers License Number (required)

How Did You Find Out About Us?



Pets Name (required)

Pets Birth Date (required)

Breed (required)

Color (required)


I hearby authorize the Doctors (and their designated associates or assistants) to examine, prescribe for, and treat, or perform anesthesia / surgery upon the above-described pet. I agree to pay for the services rendered at the time the pet is discharged from the clinic or when service is otherwise terminated.

Veterinary Service during nighttime hours, some daytime hours, and / or weekends, is provided at the discretion of the veterinarian in charge. Continuous presence of personnel may not be provided during these hours. (Calif Code of Regs Title 16 section 2030)