Client/Patient Information Form

Name: McFarland Animal Hospital
Address: 5620 HWY 51, McFarland, WI, 53558, United States
Telephone: 608-838-3400
Price range: $

APPOINTMENT

Thank you for giving us the opportunity to care for your pet. Please fill out this form as completely and accurately as possible!

Owner Name *

First

Last

Address

Address Line 1

City

State

Zip Code

Home Phone

Cell Phone

Work Phone

Employer

Email *

Having your email address on file with us will give you online access to your pet's records. We will only use your email address to communicate with you about your pet, to send you product updates, as well as promotions. We respect your privacy and do not tolerate spam. We will never sell or share your email address with any third parties. You may also unsubscribe at any time.

Who else is responsible for your pets?

Name

First

Last

Address

Address Line 1

City

State

Zip Code

Home Phone

Cell Phone

How did you first hear about us?

Referral
Hospital Sign
Yellow Pages
Bucky Book
Newspaper
Our website
Google
Yahoo
Bing
Phone company website directories
Other

Whom may we thank for their referral?

If other, please explain:

Find us on Facebook! We occasionally post photos of pets on our Facebook page. Do we have your permission to highlight your pet on our page? We will only post the pet's first name. *

Yes, you have my permission to post about my pet.
No, you do not have my permission to post about my pet.

Full payment is required at the time services are provided. At your request, we will provide you with a written estimate of fees for any treatments. You are responsible to notify us if any of the above information changes. *