Client Information Form | North County Cat Hospital

Client Information

The form on this page is to give us information about you.

Patient Information

Client Information

To fill out the form to give us information about your cat, please click here.

Email List

The form on this page won't add you to any Internet lists.

To fill out the form to be added to our emailing list, please click here.

This Long Form

This form is designed to give us a lot of potentially useful information about you. The only things we really need to know about you in order to create a legally acceptable medical record are in bolded blue boxes. We also need the CAPTCHA at the end (the "I'm not a robot" thing).

About the Term "Owner"

There is legitimate controversy about the correct term to use for the person responsible for the pet. The organization IDA is adamant that the word "guardian" should be used. The organizations AVMA and AKC support the word "owner". The ASPCA seems to use both terms randomly. PETA seems to use "owner" when they talk about negative stories and "guardian" with positive stories. Some people prefer caretaker, others feel that humans have cats and cats have humans.

We use the word "owner" on our forms when describing you, the person, because that is the term that everyone understands.

If you prefer a term other than "owner", please make a selection.

Guardian

Caretaker

Human

Other

If you have been here before and are updating your information for us, please check this box.

If you are updating your information and have a new name, what was your previous name?

Owners

To become a client, you must be at least eighteen years old.

Are you at least 18 years old?

Yes

Address:

Phone Numbers

Primary Contact Phone Number

If we call, this is the first number we'll try.

Please select an option

Home

Cell

Work

Other

If this is not the phone number of the first person listed, whose is it?

We usually call or text clients to get updates, confirm upcoming appointments, etc., between 9:00 am and 9:00 pm. on weekdays. If your preferred contact times for this phone are different, please indicate here.

Do not call before:

Do not call after:

Secondary Contact Phone Number

If it's important / urgent, this is the second number we'll call.

Select an option

Home

Cell

Work

Other

If this is not the phone number of the first person listed, whose is it?

Do not call before:

Do not call after:

Other phone contact information:

Please add other numbers, information here:

Email Addresses

Primary Contact Email

If this is not the email address of the first person listed, whose is it?

Additional Contact Email

If this is not the email address of the second person listed, whose is it?

Other email information:

Please add other addresses, information here:

Final Things:

How did you first hear about us?

Is there anything else that you would like us to know?

We will gladly prepare a written estimate if you desire. Please ask the receptionist or doctor.

All fees are due at the time services are rendered.