New Patient Form

If your pet is a dog

If your pet is a cat

YesNo
YesNo

Owner's Information

Referral

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I hereby authorize the veterinarian to examine, prescribe for, and/or treat the above described pet. I assume full responsibility for all charges incurred for the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for surgical treatment. (SEAL)

YesNo
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