New Client Information

Please fill out the required fields and submit the form.

Owner Information
Name of Owner
Name of Spouse/Partner
Address
City
State
Zip
Owner Contact
Home Phone*
Cell Phone*
Work/Other Phone
Spouse/Partner Contact
Home Phone
Cell Phone
Work/Other Phone
Owners Email
Spouse/Partner Email
To be used for e-mail reminders, special events, offers, and client communication.
How did you hear about us?
Pet Information
Pet Name
Date of Birth
Type of Pet
Breed
Color
Sex
Authorization Agreement
As owner of record, I hereby authorize the doctor(s) to examine, prescribe for, and treat any animal(s) I present to Akaal Pet Hospital. I assume responsibility for all charges incurred in the care of this/these animal(s). I also understand these charges are to be paid at the time of release and that a deposit may be required for surgical treatment or hospitalization.
Type Name as Signature
Date

Accepted methods of payment: Cash, Mastercard/ Visa, Discover, AmEx, Debit Cards, and CareCredit.
Unpaid checks will be turned over to Sheriffs Department.

We are easily accessible from Carmichael, Roseville, North Highlands, Antelope, and Sacramento.


Akaal Pet Hospital


6081 Greenback Lane


Citrus Heights, CA 95621


Phone: (916) 729-7779


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