Kingstowne Cat Clinic, LLC I 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-6pm Tuesday: 8am-6pm Wednesday: 8am-6pm Thursday: 8am-6pm Friday: 8am-6pm In 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 Information Owner's Name: Spouse/Other: Address: City: State: Zip: Email: Occupation: Home Phone: Cell Phone: How do you prefer we contact you?: Home PhoneCell PhoneTextEmail How 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 Kitty Name: Breed: DOB: Sex: MaleNeutered MaleFemaleSpayed Female Color: Microchip #: Second Kitty Name: Breed: DOB: Sex: MaleNeutered MaleFemaleSpayed Female Color: Microchip #: Third Kitty Name: Breed: DOB: Sex: MaleNeutered MaleFemaleSpayed Female Color: Microchip #: Upload Records: Please Read Carefully Before Signing Kingstowne Cat Clinic has business and medical staffing hours as follows: 1. Monday and Thursday: 8:00 am to 7:00 pm 2. Tuesday, Wednesday, and Friday: 8:00 am to 6:00 pm 3. Weekends and Holidays: Closed Therefore, this is to inform you that we have no in-house, on duty continuous medical staff care on: a) Weekdays from Closing time until the following business day at 8:00 am. b) Weekends from Closing time on Fridays or Saturday (depending on the alternating weekend) until 8:00 am on the following Monday. c) Holidays from Closing time before the Holiday until the opening time the day after the Holiday *Signature: (Please type your name) HomeWorkCellEmailText