Welcome Form in Bel Marin Animal Hospital

New Patient Welcome Form

We are pleased to welcome you to our practice! Please take a few minutes to fill out this form as completely as you can. If you have questions we’ll be glad to help you. We look forward to working with you in maintaining your pet’s health.

How did you learn about our practice? (Please check what applies)
Preferred Method of Contact:

Pet Information


Forms of Payment

We accept Cash, Checks, Amex, Visa, MasterCard, Discover, Debit & Care Credit. All professional fees are due at the time service is rendered. In cases of extensive medical or surgical procedures, a deposit may be required. There will be a service charge for any check returned unpaid.

Signature of client responsible for pets or duly authorized agent for owner.