Client & Patient Information Form

Angel Animal Hospital
24307 Halsted
Farmington Hills Mi, 48335

Owner Information: (must be completed in full)

* YesNo

Pet Information: (must be completed in full)

* MaleFemale
* YesNo
* DogCatOther
IndoorOutdoorBoth
* YesNo

I, the undersigned, do hereby certify that I am the owners (or duly authorized agent for the owner) of the animal described above and of 18 years of age or older. I understand that every effort will be made to be achieve a successful outcome, and to provide for all the possible safety in hospital care and handling.
I hereby authorize this hospital to receive, prescribe, treat, or perform surgery upon the pets on file and any additional pet I present. Furthermore, I agree to pay these fees in full for the services rendered at the time the pet is admitted to the hospital. Accounts not paid within terms are subject to a 1.5% monthly finance charge.

I understand that veterinary service is not provided during the nighttime hours. If I neglect to pick up my pet within three (3) days of discharge date agreed upon and do not notify you within that time period, you may assume that the pet is abandoned and are hereby authorized to dispose of the pet as you deem best or necessary.

* Required field.