{"id":3987,"date":"2021-06-21T15:25:02","date_gmt":"2021-06-21T15:25:02","guid":{"rendered":"http:\/\/localhost\/victor\/wordpress\/?page_id=3987"},"modified":"2024-03-29T02:11:45","modified_gmt":"2024-03-29T02:11:45","slug":"new-client-form","status":"publish","type":"page","link":"https:\/\/laveterinarycenter.com\/jeffersonpark\/new-client-form\/","title":{"rendered":"New Client Registration Form"},"content":{"rendered":"\t\t
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New Client Register<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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    PRIMARY OWNER *\n\t\t<\/p>\n\t\t

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    First Name* <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    Last Name* <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

    Date of Birth <\/span>\n\t\t<\/p>\n\t<\/div>\n

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    SECONDARY OWNER\n\t\t<\/p>\n\t\t

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    First Name <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    Last Name <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

    Date of Birth <\/span>\n\t\t<\/p>\n\t<\/div>\n

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    Address\n\t\t<\/p>\n\t\t

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    <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    City <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    State <\/span>\n\t\t<\/p>\n\t<\/div>\n

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    Preferred Contact Phone #* <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

    Phone Type

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    Alternate Contact Phone # <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

    Phone Type

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    Email <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    May we send you text message notifications ?
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    Preferred Method of Communication
    \nCall<\/span><\/span>Text<\/span><\/span>Email<\/span><\/span>Postmail<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t

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    How did you learn about us ?
    \nWalk\/drive by<\/span><\/span>Here Previously<\/span><\/span>Internet<\/span><\/span>Yelp<\/span><\/span>Google<\/span><\/span>Friend Relative<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

    If friend\/relative: Whom may we thank <\/span>\n\t\t<\/p>\n\t<\/div>\n\t

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    Appointment Date and time (If you don't have an appointment, please call us at 323-685-7131 to schedule today!)\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    Date <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    Time <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

     \n\t\t<\/p>\n\t<\/div>\n\t

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    Pet name* <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    Dog or cat
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    Breed* <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    Age\/Date of birth* <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    Color* <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    Sex

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    Spayed \/ Neutered

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    Microchip # <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    Previous Doctor \/ Clinic Name <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    May we request records?
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    Vaccination History <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    Upload Attachments (Ex: X-ray Images of Previous Test Reports)
    \n<\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    Additional Attachments
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    May we use photos of your pets on social media?<\/strong>
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    I, the undersigned, owner, or authorized agent of the above patient hereby authorize the admitting(and his designated associates\/assistants) to administer such treatment as needed for the benefit of this patient. I also consent to the administration of such anesthetics as needed. I further understand that no guarantee of successful treatment is made. I also assume financial responsibility for all charges incurred to this patient and agree to pay all such charges at the time the patient is released. PAYMENT IS DUE AT THE TIME OF SERVICE.\n\t\t\t<\/p>\n\t\t\t

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    Signature of Preferred Owner*<\/strong>

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    Today date* <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

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    Signature of Preferred Owner<\/strong>

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    Today date <\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t

     \n\t\t<\/p>\n\t<\/div>\n\t

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    \n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>

    <\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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    <\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

    New Client Register<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-3987","page","type-page","status-publish","hentry"],"yoast_head":"\nNew Client Registration Form - Los Angeles Veterinary Center<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/laveterinarycenter.com\/jeffersonpark\/new-client-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"New Client Registration Form - Los Angeles Veterinary Center\" \/>\n<meta property=\"og:description\" content=\"New Client Register\" \/>\n<meta property=\"og:url\" content=\"https:\/\/laveterinarycenter.com\/jeffersonpark\/new-client-form\/\" \/>\n<meta property=\"og:site_name\" content=\"Los Angeles Veterinary Center\" \/>\n<meta property=\"article:modified_time\" content=\"2024-03-29T02:11:45+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/laveterinarycenter.com\/jeffersonpark\/new-client-form\/\",\"url\":\"https:\/\/laveterinarycenter.com\/jeffersonpark\/new-client-form\/\",\"name\":\"New Client Registration Form - 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