Client/Patient Information Form

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Client/Patient Information Form

Please complete our Client/Patient Form. All fields marked with * are required and must be filled.

The following individual(s) is designated as alternate to give consent for services in my absence. The designation remains in place until the hospital is otherwise notified. As the owner, you are still responsible for any charges incurred by the consent given by the alternate individual.

NOTE: For the safety of all animals here, it is our policy that all animals be up to date with their vaccinations in order to be hospitalized or boarded.

Patient 1:

ALL FEES ARE REQUIRED TO BE PAID IN FULL UPON COMPLETION OF THE VISIT. In the event any balance due hereunder is not paid as agreed, the undersigned jointly and severally agree to pay all costs included in said unpaid balance, including a reasonable collection and/or attorney's fees.

Click or drag a file to this area to upload.

I, the undersigned, am at least 18 years of age and hereby state that I am the owner/caregiver of the above-specified animals.

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