New Client Form

Patient Information:

Pet #2 (If applicable)

Upon request we will gladly prepare a written estimate, just ask one of our technicians. Payment is due at the time services are rendered. To help prevent the spread of infectious diseases, ALL hospitalized animals must be current on all vaccines. I understand every effort will be made to achieve a successful outcome and to provide for all possible safety in hospital care and handling. I hereby authorize this hospital to receive, prescribe for, treat or perform surgery upon the pet listed above. Furthermore, I agree to pay fees for services rendered at the time the pet is discharged from the hospital, or the service is otherwise terminated. I agree to pay for the reasonable costs of collection in the event that collection efforts become necessary. I understand that audio recording may be used during my appointment as a means to streamline notetaking and hospital efficiency, but audio is not kept or stored by RVC. I understand that I must confirm my appointment at least 24 hours in advance, or it may not be held.

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