Welcome to Sheridan Animal Hospital
Thank you for giving us the opportunity to care for your pet. We will be happy to answer any questions you have about your pet’s health. To insure the best care possible, please take the time to fill in this form completely. Thank you!
Owner's Name:__________________________________________________ 
Address:________________________________________________________ APT. #______
City:__________________		State:________ 		Zip: _________
Home #__________________  Cell #___________________  Work #________________ 
Email: _________________________________________________
Driver License # _________________________________________
************************************************************************
Pet's Name: ___________________________
Species (circle)  Canine		Feline 		Other:________________ 
Breed:_______________ 	Sex: Male / Female 	Spayed/ Neutered?  Y or N 
Color(s): __________________________________
Age or Birthdate: ____________________________
Reason for today's visit:__________________________________________
************************************************************************
Pet's Name: ___________________________
Species (circle)  Canine		Feline 		Other:________________ 
Breed:_______________ 	Sex: Male / Female 	Spayed/ Neutered?  Y or N 
Color(s): __________________________________
Age or Birthdate: ____________________________
Reason for today's visit:__________________________________________
*************************************************************************
Authorization: I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment.
Yes___ 	or	No___ 
Signature:______________________________________________