New Client Form

Pet information

* Indicated required field

By selecting below I authorize the veterinarian/staff of Hospital for Veterinary Surgery to examine, treat, and prescribe for the above described pet. I understand that all hospitalized patients must be vaccinated for rabies. I assume financial responsibility for all charges incurred in the care of the animal. I also understand that payment is due in full at the time of services rendered.

I grant Hospital for Veterinary Surgery, its representatives and its employees the right to take and/or use photographs of my pet(s). I authorize Hospital for Veterinary Surgery, as it assigns and transfers to copyright, use and publish the same print and/or electronically without compensations. I agree that Hospital for Veterinary Surgery may use such photographs of me and/or my pet(s) with or without my name and/or my pet(s)name and for any lawful purpose, including but not limited to publicity, illustration, advertising and web content.