Kingstowne Cat Clinic, LLCI hereby give my permission to the business entity known as the Kingstowne Cat Clinic to:Maintain my personal information for purposes of maintaining a record of myself and my pets.Transmit my pet or pet’s medical record to the facility of my choice, should I so request it.Furthermore, I understand that payment is due at time of services rendered. I understand that the Kingstowne Cat Clinic is unable to serve as a creditor and cannot extend credit for services rendered.Please be advised: Kingstowne Cat Clinic does not have in-house care, 24 hour medical staff outside of normal business hours which are as follows: Monday: 8am-7pm Tuesday: 8am-6pm Wednesday: 8am-6pm Thursday: 8am-7pm Friday: 8am-6pmIn the event of an overnight surgery or boarding, a staff member will be here to check on/provide food and any medications twice daily. Owner InformationOwner's Name: Spouse/Other: Address: City: State: Zip: Email: Occupation: Home Phone:Cell Phone:How do you prefer we contact you?: Home PhoneCell PhoneTextEmailHow did you hear about our practice?: Alexandria TimesBeulah CorridorClinic WebsiteDrive By/buildingFacebookInternet SearchKingstonianOther AdsSignageWord of MouthYellowpages/YelpIndividual we may thank (please specify below)If referred, please provide the name:First KittyName: Breed: DOB: Sex: MaleNeutered MaleFemaleSpayed FemaleColor: Microchip #: Second KittyName: Breed: DOB: Sex: MaleNeutered MaleFemaleSpayed FemaleColor: Microchip #: Third KittyName: Breed: DOB: Sex: MaleNeutered MaleFemaleSpayed FemaleColor: Microchip #: Upload Records: *Signature: (Please type your name)