Name: Sierra Ranch Veterinary Clinic
Address: 8711 Sierra College Blvd Suite 1, Roseville, CA, 95661, US
Telephone: (916) 774-6630
Price range: $$

New Client Registration Form

Welcome to Our Practice!

Thank you for choosing Sierra Ranch Veterinary Clinic & Pet Rehabilitation Center to care for your pet(s). We strive to offer exceptional customer service and quality veterinary medicine. Please take a moment to fill out the following information so we can add you and your pet(s) to our system. Do not hesitate to ask if you have any questions.

Client Information
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mobile Phone
Home*
Work
Email*
Your email address will not be sold. It may be used by us to send appointment reminders, electronic records, promotional, and product information.
Enter Email Confirm Email
DOB (to dispense controlled medications)
Driver's License:
Additional Contact
Name
First Last
Phone*
Relationship
Phone
Emergency Contact*
First Last
Pet Insurance
How did you find out about our practice?
- Clinic Location
- Personal Referral
- Internet Search / Website
- Clinic Sign
- Newspaper / Print Media
- Other
If Other, please specify:
Pet Information
Pet's Name*
Date of Birth or Age (if known)
Date of last vaccines (if known)
Date Format: MM slash DD slash YYYY
Species*
Breed (if known)
Color
Sex
Is your pet on any medication or supplement?
- Yes
- No
If Yes, please list the medication or supplement
Please use the following box to give us any other relevant information about your pet
Pet #2 Information
Pet's Name
Date of Birth or Age (if known)
Date of last vaccines (if known)
Date Format: MM slash DD slash YYYY
Species
Breed (if known)
Color
Sex
Is your pet on any medication or supplement?
- Yes
- No
Please use the following box to give us any other relevant information about your pet
*
- I hereby authorize Sierra Ranch Veterinary Clinic & Pet Rehabilitation Center to examine, prescribe for, treat, or perform surgery on my pet(s). I also consent to the administration of anesthetics as necessary.
*
- I agree to pay fees for services rendered at the time of discharge from the facility or when service is otherwise terminated. I agree to pay a deposit if needed at drop-off of no less than 50% of the estimate of service.
*
- I understand that an appointment is required to be made for services. In the event I do NOT show for my appointment, I will be charged a fee. 24-hour notice of cancellation is required to avoid being charged a fee.
*
- I understand that my pet(s) need to be current on their rabies vaccination before any services are rendered.
*
- I authorize the sharing of veterinary medical information between veterinarians or facilities for the purpose of diagnostics or treatment of my pet.
*
- I understand that Sierra Ranch Veterinary Clinic & Pet Rehabilitation Center is NOT a 24-hour facility and that veterinary services and personnel will NOT be providing care during night time hours.
*
- If medical records for my pet(s) are requested from another veterinarian, veterinary facility, rescue, merchant services, or insurance company, I authorize Sierra Ranch Veterinary Clinic & Pet Rehabilitation Center to provide the records.
*
- I authorize the use of pictures of my pet(s) for the purpose of social media advertisement, webpages, in-clinic information board and/or educational mailers for Sierra Ranch Veterinary Clinic & Pet Rehabilitation Center.
Date*
Date Format: MM slash DD slash YYYY
Consent*

Veterinary Clinic

Clinic Phone: (916) 774-6630
Email: info@sierraranchvetclinic.com

Pet Rehabilitation Center

Rehab Phone: (916) 789-7722
Email: info@sierraranchpetrehab.com

Location

8711 Sierra College Blvd Suite 1
Roseville , CA, 95661

Hours

Mon-Fri: 8:00am-7:00pm
Saturday: 8:00am-2:00pm
Sunday: Closed

New Client Registration Form

Welcome to Our Practice!

Client Information

Additional Contact

Pet Information

Pet #2 Information

Veterinary Clinic

Pet Rehabilitation Center

Location

Hours