Owner / Caregiver

Please provide the information below as completely as possible.

Pet Information

Statement Of Ownership

By checking below you certify that you are the owner and or agent of the above animal and have the authorization to consent to treatment if and when it is needed.

How did you hear about us?

Why is your pet visiting us? What are his/her symptoms?

I hereby authorize the Veterinarian(s) and staff to examine, prescribe for, and/or treat the above-described pet. I assume responsibility for all charges incurred in the care of this animal. I understand that payment is due at the time of service and billing is NOT offered and a deposit may be required prior to treatment or hospitalization. Estimates are available upon request. Personal Checks are not accepted at a first visit, Cash, Visa, MC, Amex, and Discover are accepted.