WELCOME AND THANK YOU for choosing Hartland Animal Hospital.  Our mission is to provide quality health care, with a friendly, dedicated staff that strives to treat your pets with respect, dignity, kindness, and compassion as if they were our own.

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I am a new client
I am currently/previously a client
Owners Name (s)
Mr. Mrs.MissMs.
* Last Name
* First Name
MI
Last Name
First Name
MI
* Address
* City
* State* Zip
* Home Telephone
Work TelephoneCell Phone
Email Address

Patient Information:
* Name
* SpeciesCanineFelineOther
Breed
ColorDate of Birth
* SexMaleNeuteredFemaleSpayed
Previous Veterinary Care:  Name of Clinic/Veterinarian
MicrochippedYesNo

Vaccination History

CanineDistemperRabiesLymeBordetella
Heartworm TestingCurrently on Heartworm Preventative
Boarding/Classes/GroomingPuppy ClassesBoarding KennelGrooming
FelineDistemperRabiesFeline LeukemiaFeline Leukemia Testing
Any Pre-Existing Conditions:

I am the responsible owner or agent of the above patient and have the authority to execute this document.  I UNDERSTAND THAT PAYMENT IS EXPECTED IN FULL AT THE TIME SERVICES ARE RENDERED. WE HONOR VISA, MASTERCARD, DISCOVER CARD, DEBIT CARD, CHECKS AND CASH
Signature
Date
I was referred to Hartland Animal Hospital by
I learned of the Hartland Animal Hospital from
 Hospital Hours are:
Monday -Thursday 7:00 AM - 6:00 PM
Friday 7:00 AM- 5:00 PM
Saturday 7:00 AM - Noon
Phone: (262) 367-3322
Fax: (262) 367-3362