Register Online

Register online and receive a discount

Receive a 10% discount on your next visit to Horizon Animal Hospital when you register your pet(s) using our web based registration form. This offer is good for both new and existing clients.

Only one discount per family, valid for only one visit and the discount must be used within 90 days of the date of the confirmation e-mail. Maximum discount value equals $100.

Fill in the blanks provided below then submit the form. We will input your information into our client database and send your confirmation by e-mail. To receive the discount all required information (*) must be completed on the form. If a required field in not applicable (for example you don't have a middle initial) enter a blank in the field using the space bar.

The discount is valid for all goods and services, however, it must be used in conjunction with a Doctor’s visit (i.e. not valid to only purchase retail merchandise).

This discount is not valid with any other discount offers, however, it may be used in conjunction with other discounts. For example, if you have a discount coupon for grooming you may not receive an additional 10% off the discounted grooming fee, however, you may use the discount for the remainder of your bill. The information collected on this form will be treated with strict confidentiality and used solely for the purpose of setting up and/or updating your client records.

Owner

Name: *

Home Phone: -- *

Emergency Contact:

Emergency Phone: --

Address: *

Apt/Suite:

City: *

State: *

Zipcode: *

E-Mail Address: *

Confirm E-Mail: *

Work Phone: --

Work Extension:

Place of Employment:


Spouse/Co-owner

Name:

Home Phone: --

Emergency Contact:

Emergency Phone: --

Address:

Apt/Suite:

City:

State:

Zipcode:

E-Mail Address:

Confirm E-Mail:

Work Phone: --

Work Extension:

Place of Employment:


How did you find out about us?*

Referred by:  
Scottsdale Yellow Pages
Phoenix Yellow Pages
Saw your building sign
Internet Search
Our Website
Direct Mail
Other:  


Pet #1 Information

Pet's Name: *

Pet type:* Dog
Cat
Bird
Other:  

Breed:

Gender:* Male
Female

Spayed/Neutered:* Yes
No

Date of Birth:*
(MM/DD/YYYY)
/ /


Pet #2 Information

Pet's Name:

Pet type: Dog
Cat
Bird
Other:  

Breed:

Gender: Male
Female

Spayed/Neutered: Yes
No

Date of Birth:
(MM/DD/YYYY)
/ /


Pet #3 Information

Pet's Name:

Pet type: Dog
Cat
Bird
Other:  

Breed:

Gender: Male
Female

Spayed/Neutered: Yes
No

Date of Birth:
(MM/DD/YYYY)
/ /


Enter Access Code: