Register your Pet
PATIENT INFORMATION

Register your pet online to join our mailing list for special promotions, discounts, coupons, newsletters, special care and treatment
New Client     New Patient     Old Patient
Pet Name * :
Gender * :
Male Female
Neutered * :
Yes No Not Sure
Approximate Date of Birth * :
Color * :
Breed * :
Previous Veterinarian * :
Please tell us about your pet in detail * :
How did you first hear of us * :
Internet Hospital Sign Yellow Pages Referral Other
OWNER OR AUTHORIZED AGENT INFORMATION
Owner Name * :
Address * :
City * : State * :
Zip Code * :
Email * :
Home Phone#: Cell Phone# * :
Work Phone#: Other #:
Emergency Contact Name:
Emergency Contact Number
 
By clicking Yes ! I want to register now, I agree I am the person 18 years of age or older responsible for registration of my pet with Oakelm Animal Hospital to recevice newsletters, coupons, discount and care from time to time.