Current Client Registration Form (New)

Owner's Information

Primary Owner’s Name(Required)
Primary Owner’s Address(Required)

Secondary Owner's Information

Secondary Owner’s Name
Secondary Owner’s Address

Pet's Information

Be as specific as possible. We must use this information to send records to your regular veterinarian’s office. If you do not have one, please enter “None”.
Authorization & Fee Policy I hereby authorize the veterinarian on duty and assistants the doctor may designate to administer treatment as is considered necessary. The
reasons such treatment is considered necessary, its advantages and possible complications and possible alternative treatment will be explained to
me by the doctor. I also certify that no guarantee has been made as to the results that may be obtained. I consent to release all medical
information. I hereby certify that I have read and understand the above authorization for treatment.

Professional Fee Policy: The fee for the emergency examination by the veterinarian is $170.00. An additional $25.00 fee will be added from 8pm to
8am and on observed holidays. Additional fees are charged if treatment, medication, and/or hospitalization is necessary. An estimate of total cost
may be obtained from the veterinarian. A deposit may be requested. Fees are to be paid at the time of service. We accept multiple forms of
payment including Cash, VISA*, Mastercard*, Discover Cards* as well as Scratch Pay and Care Credit.

*Please note – when using a credit/debit card as payment that a 3.5% transaction fee is added to the total amount due per transaction.

Please indicate the method of payment below, sign and date.
How will you be paying?(Required)
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I understand and acknowledge that...(Required)
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CPR/DNR

Please confirm your wishes regarding your pet’s CPR or DNR status. Please note the following regarding CPR in pets:
• If your pet suffers cardiopulmonary arrest (their heart stops and/or they stop breathing), you have the choice to authorize or decline CPR.
• CPR in pets will include orotracheal intubation, chest compressions, IV catheter placement with administration of emergency drugs, etc.
• CPR itself causes trauma. Secondary complications related to performing CPR generally include pulmonary contusions and rib fractures.
• If CPR is performed, statistically your pet will have a 2%-7% probability of recovering and then later being discharged from the hospital.
• The fee for CPR alone will be approximately $430. If your pet is resuscitated, they will then require further care and hospitalization to address the underlying cause of their arrest and to also address any secondary complications as noted above. For a pet that is resuscitated following CPR, you should expect a minimum of $2000 in continued care, but an individualized estimate will be provided based on your pet’s condition and cause for arrest.
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