New Client Registration Form

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Home Phone

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Thank you for choosing Wake Veterinary Medical Center! Our primary mission is to provide compassionate care, affordable rates, and superior comprehensive veterinary care with a family approach. We diligently strive to ensure that the cost of quality veterinary care is as economical and manageable for our clients as possible by offering multiple payment options.

We offer multiple payment options in the form of: Cash, Visa, MasterCard, Discover, American Express, and Care Credit.

Any necessary treatments and/or hospitalized care will be provided an estimate.

**Wake Veterinary Medical Center requires payment in FULL at the time of check out.**

By signing below, you acknowledge and fully understand the Wake Veterinary Medical Center financial policy and agree the Wake Veterinary Medical Center terms of payment.

Electronic Signature(Required)

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Pet Registration

1st PET INFORMATION

Pet Name

Species

Dog

Cat

Reptile

Exotic

Breed

Color

Date of Birth

If unknown, approximate age:

Sex

Male

Female

Spayed/Neutered?

Yes

Is your pet up to date on vaccines?

Yes

Please list prior illnesses, surgeries, or allergies:

Is your pet currently on any medications?

Yes

Names and dosage:

2nd PET INFORMATION

Pet Name

Species

Dog

Cat

Reptile

Exotic

Breed

Color

Date of Birth

If unknown, approximate age:

Sex

Male

Female

Spayed/Neutered?

Yes

Is your pet up to date on vaccines?

Yes

Please list prior illnesses, surgeries, or allergies:

Is your pet currently on any medications?

Yes

Names and dosage:

Photo Consent

I hereby grant Wake Veterinary Medical Center permission to take photographs of my pet(s), and to publish those photographs for any lawful purpose, including but not limited to their website, social media accounts, and promotional materials either digital or in print, in perpetuity. I understand that Wake Veterinary Medical Center will not use my name or my pet's name.

By electronically signing this form I authorize Wake Veterinary Medical Center to edit and share the photograph(s) mentioned above. I also waive any rights of privacy or compensation associated with the use of my pet(s) image(s) for the personal or commercial purposes outlined above.

Electronic Signature(Required)

Date(Required)

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Pet Registration

Wake Veterinary Medical Center

Primary Care Hours:

EMERGENCY: OPEN 24 HOURS EVERY DAY