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

Rehabilitation New Client Registration Form

Welcome to Our Pet Rehabilitation Center!

Thank you for choosing Sierra Ranch Veterinary 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
Cell*
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
Relationship
Phone
Emergency Contact*
First Last
Phone*
Pet Insurance
How did you hear about us?
Patient Information
Pet's Name*
Age/DOB (If Known)
Last Rabies Vaccine (If Known)
Date Format: MM slash DD slash YYYY
- Dog
- Cat
Breed (if known)
Color
Sex
Patient #2 Information
Pet's Name
Age/DOB (If Known)
Last Rabies Vaccine (If Known)
Date Format: MM slash DD slash YYYY
- Dog
- Cat
Breed (if known)
Color
Sex
*
- I hereby authorize Sierra Ranch Pet Rehabilitation Center to examine, prescribe for and treat my pet(s).
*
- I agree to pay fees for services rendered at the time of discharge from the facility or when service is otherwise terminated.
*
- 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 session fee. 48-hour notice of cancellation is required to avoid being charged a session fee.
*
- A rehabilitation session is up to 1.5 hours of therapy. If I am late, treatment will be adapted to fit within my session time.
*
- In the event my pet vomits or has a bowel movement in the underwater treadmill I am aware that I will be charged a $90.00 cleaning and sanitation fee.
*
- If my pet is found to have external parasites (i.e.: fleas, ticks, mites) my pet will be treated and all expenses related to treatment will be my responsibility.
*
- Female pet in season may not be allowed to participate in certain modalities of physical rehabilitation.
*
- If my pet is found to be aggressive or demonstrates unpredictable behavior, my pet will be required to wear a muzzle while within the facility.
*
- I understand that pets within the facility may carry transferable disease or illness. I understand that my pet may be susceptible and that I am financially responsible. The center is not liable for disease or illness my pet contracts.
*
- 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.
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

Rehabilitation New Client Registration Form

Welcome to Our Pet Rehabilitation Center!

Client Information

Additional Contact

Patient Information

Patient #2 Information

Veterinary Clinic

Pet Rehabilitation Center

Location

Hours