New Client Registration FormThank you for giving Prefurred Pets the privilege of caring for your most valuable pet(s). So that we may better serve you, please fill out the form belowName*Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Alternate PhoneEmail* Spouse/ Co-OwnerBest time and/or method to reach you Email Phone TextHow did you become aware of our services? (Check one)WebsiteFacebookReferral(Their Name so we may thank them)I assume responsibility for all charges incurred in the care of this animal. I also understand that payment is due at the time services are rendered.Signature*PetNameBirthdayBreedSex: Spayed/NeuteredColor Previous medical records may be obtained from:Any special diets or medications?Any serious illnesses or surgeries?Any allergic reactions to vaccines or medications?Referral- Who may we thank for recommending our services?CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
