New Client Registration Form

If you and your pet(s) are new to Mercy Pet Hospital, or if you are already established with us but need to update your information, we encourage you to fill out this form and bring it with you at the time of your pet’s next appointment.

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Your e-mail address will be kept private and only used by Mercy Pet Hospital, Inc. for the purposes of communication and notifications.

Authorized Person on Account (must be 18 years of age)

I authorize Mercy Pet Hospital, Inc. to publish the photographs taken of me and/or my pet for use in printed publications and websites. I acknowledge that since my participation in publications and websites produced by Mercy Pet Hospital is voluntary, I will receive no financial compensation. I further agree that my participation in any publication and website produced by Mercy Pet Hospital, Inc. confers upon me no rights of ownership whatsoever. I release Mercy Pet Hospital, Inc., their contractors and its employees from liability for any claims by me of any third party in connection to my participation.

Patient Information

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Spayed / Neutered(Required)