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Client Registration

Register Your Pet Here

We are pleased to welcome your pet(s) to our practice. Please take a few minutes to fill this form. If you have any questions, we're happy to help.

Can we send text messages to your number?
Yes
No
For non-emergency communication, I prefer to be contacted by:
Text
Email

If you personally experience an emergency (e.g. fainting) while at our clinic, whom should we call?

YOUR PET INFO

Species
Cat
Dog
Other

Examples: Beagle mix or Domestic Shorthair

Species
Male
Female
Spayed or Neutered?
Spayed Female
Neutered Male
Intact (Not Spayed or Neutered)

Examples: Tri-color or Black with white spots

Is this pet micro-chipped?
Yes
No
I'm not sure

Please list previous all veterinary clinics. We will call them for records. If you have records from a mobile clinic, breeder, or rescue; we ask you to email a copy or photo of the records prior to your pet's first appointment.

Photography Release

Sometimes we use photos of our patients. We only use the pet's name, never the owner's name without prior permission. Unless indicated otherwise, I hereby give permission for photos of my pet (s) to be taken and used for publication, education purposes, and/or promotion of Compassion Veterinary Care.

Regarding the use of my pet's picture:
I authorize the use of my pet's picture
I DO NOT authorize the use of my pet's picture

Authorization For Treatment and Credit Agreement

I hereby authorize the Veterinarian(s) to examine, prescribe for, or treat the above-described pet(s). I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges are due at the time services are rendered. If a balance is unpaid after services are rendered, I agree to pay a service charge of five percent (1.5%) per month computed on the unpaid balance until the account is paid in full. I also agree to pay all attorney fees, collection agency fees, court fees and all other costs incurred in our collection process on all unpaid balances I may owe.


I understand that if anyone else other than myself brings in my pet or picks my pet up, then they need to be responsible to pay the bill in full when the services are rendered or prior to the release of the animal.

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