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Owner's Name
Pet's Name
Phone
Email
Date of Birth/Approximate Age
Primary Color
Breed
Species
Canine
Feline
Sex
Male
Female
Unknown
Has your dog/cat been spayed/neutered?
Yes
No
Who is your pet’s previous veterinarian?
Previous veterinarian's phone number?
Do you authorize the release of your pet’s medical records to Crestview Veterinary Clinic?
Yes
No
Signature
Date
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