P.E.T.S. Wichita Falls Wellness Form Date of Appointment* MM slash DD slash YYYY Owner Name*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Cell Phone*How Did You Hear About P.E.T.S.? Friends or Family Google Search Facebook Have You or Your Pet Been to P.E.T.S. Before?*SignatureBy typing my name above and submitting this form, I hereby agree that the procedures agreed upon in the followup call are approved by me. To my knowledge my cat/dog is healthy and has not bitten anyone in the past ten days. I agree to hold harmless and release from liability P.E.T.S. Low Cost Spay and Neuter Clinic from any illness or fatality that results from my pet receiving treatment(s).Pet 1Please fill out the pet section for each of the pets you have scheduled for appointment today. Pet Name 1*Species* Dog Cat Breed*Color*Age*Sex* Male Female Spayed or Neutered?* Yes No Pet 2If you have scheduled 2 pets, please fill in this section for your 2nd pet.Pet Name 2Species Dog Cat BreedColorAgeSex Male Female Spayed or Neutered? Yes No Pet 3If you have scheduled 3 pets, please fill in this section for your 3rd pet.Pet Name 3Species Dog Cat BreedColorAgeSex Male Female Spayed or Neutered? Yes No Pet 4If you have scheduled 4 pets, please fill in this section for your 4th pet.Pet Name 4Species Dog Cat BreedColorAgeSex Male Female Spayed or Neutered? Yes No Pet 5If you have scheduled 5 pets, please fill in this section for your 5th pet.Pet Name 5Species Dog Cat BreedColorAgeSex Male Female Spayed or Neutered? Yes No CAPTCHA