New Client Form

Complete your new client form online! If you have any questions, please call us directly at 702-242-9044.

Primary Account Holder *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Secondary Account Holder

First

Last

Primary Phone

Relation To Primary Account Holder

Do you have pet insurance? If you do, please list the company below:

Pet #1 Information - Please include name, species, breed, color, gender, and if they are spayed or neutered. *

Pet #2 Information - Please include name, species, breed, color, gender, and if they are spayed or neutered.

Pet #3 Information - Please include name, species, breed, color, gender, and if they are spayed or neutered.

PHOTO AND MEDIA RELEASE: Durango Animal Hospital will take photos of you and/or your pet as needed for our medical records. We ask your permission to take additional photos to copyright, use, and publish in print and/or electronically. We may use such photographs for any lawful purposes, including but not limited to: publicity, marketing materials, advertising, website content, and social media content. *

DAH may use photos of me and/or my pet for uses explained above.
DAH may not take photos of me and/or my pet beyond medical records needed.

I, the owner or authorized agent for the fore-described pet(s), as primary pet parent, am at least 18 years of age and accept full responsibility for all costs incurred. I understand that as a condition of treatment by this hospital, personal financial arrangements must be made in advance. In the event that this account should go unpaid, I will be subject to the costs of collections, including attorney fees and/or collection agency fees. *