New Patient Registration

Your Information

Secondary Contact

Pet Information

Financial Considerations and Confirmation

Please read carefully and sign indicating you are the owner/caretaker of the patient listed above, and give your consent.
  • I authorize the doctors and staff of the Center for Veterinary Specialty + Emergency Care to examine my Pet.  I understand that a written estimate and additional consent form will be provided to me prior to any other procedures with my Pet.
  • I understand that a payment is due at the time services are rendered.  If my Pet is admitted for procedures other than an exam, a deposit (equal to the low end of the estimate) will be required at the time of admission and the remaining balance will be due at the time my pet is discharged from the Hospital.
  • Attention Clients Paying by Check: if your check is dishonored, you agree to pay a processing fee of $30, or any higher amount allowed by law. We may electronically debit or draft your account for this fee. Also, if your check is returned for insufficient or uncollected funds, your check may be electronically re‐presented for payment.
  • The doctors and staff at Center for Veterinary Specialty + Emergency Care frequently take photos or make video clips of patients in our care.