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.

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.