fbpx

New Client Registration Form

Name(Required)
Name
Address(Required)
During regular office hours how would you generally prefer we contact you:
How did you hear of our clinic?

Pet Health History

Species
Sex

Patient Records

Would you like to request a copy or your pet(s) previous records?

Authorization:

  • I hereby authorize the veterinarian to examine, prescribe for, or treat the above-described pet.
  • I assume responsibility for all charges incurred in the care of this animal.
  • I also understand that professional fees are due at the time services are rendered and that a deposit may be required for surgical treatment.

We will gladly prepare a written estimate if you desire. Please ask any staff member.

MM slash DD slash YYYY

Video-Photo Release

I grant Sunset Hill Veterinary & Rehabilitation Center, its representatives and employees the permission to take pictures and/or video of me and/or my pet(s), and to use, copyright, and/or publish the same in print and/or electronically.

I agree that Sunset Hill Veterinary & Rehabilitation Center may use such pictures and/or video of me and/or my pet(s) with or without the name(s) of my pet(s) and/or my name and for any lawful purpose, including, for example, such purposes as educational, publicity, advertising, and Web content.

May the above take photos of you and/or your pet(s)
MM slash DD slash YYYY