P: 440-871-6211

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F:440-871-7243

Welcome to our Clinic!

Thank you for trusting us with the care of your beloved pet.

To help us get to know you better, please complete the form below. Any medical records or information you may have for your pet,

We can’t wait to meet you and your furry friend!

Center West Animal Hospital

Thank You For Choosing Us!

Please complete the following form. Once your form has been submitted, please send all medical records or any pertinent information you may have regarding your pet(s) to centerwestanimalhospital@gmail.com.

One form per pet, please.

Client Information

First name*

Last name*

Primary Phone*

Email*

May we contact via email?

Yes

Multi-line address

Country/Region*

Address*

Address - line 2*

City*

Zip / Postal code*

Spouse/Co-Owner

Did you already schedule an appointment?*

Yes

If yes, when.

Pet Information

Pet's Name:*

Species*

Cat

Dog

Sex*

Female

Male

Neutered/Spayed*

Yes

Unknown

Breed*

Color*

Birthdate or Age*

Has your pet ever had a vaccine reaction?*

Yes

Unknown

If yes, please explain what vaccine and a brief description of what happened.

Is your pet currently on any medications?*

Yes

If yes, please list below.

May we use your pet's image on our website, social media, and/or in the clinic?*

Yes

Other

Authorization

I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of the animal. I also understand that all professional fees are due to the time services are rendered.

Signature*

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Date*

Month

Day

Year

No Call/No Show Policy

Appointment times are limited. Any appointment that is missed without prior cancellation or rescheduling, will incur a $75 "no call/no show" fee. If you must cancel your appointment, please give us a 24 hour notice.

26050 Center Ridge Road

Westlake, Ohio 44145

centerwestanimalhospital@gmail.com

P: 440-871-6211

F: 440-871-7243

Stay informed about closings due to inclement weather, power phone outages, and holiday hours by visiting our Facebook and Instagram pages for the latest updates. Your safety and convenience are our top priorities, so don’t hesitate to check in for timely announcements. Thank you for your understanding!