Client Registration Form




 

CRITICAL CARE AUTHORIZATION FORM

If your pet is arriving to our hospital in a critical state, please carefully review and complete this form.

Complete Critical Care Authorization Form

 

PET OWNER INFORMATION

PET INFORMATION

Sex
Male IntactMale NeuteredFemale IntactFemale Spayed
Up-to-date on vaccines?
YesNo
How did you learn about us?
My VeterinarianFriend/RelativeEast End WebsiteVeterinarians.com WebsiteInternet SearchRadioPrevious VisitOther

CLIENT INFORMATION

Our Emergency exam fee is $164.00.

You will be advised of estimated costs of anticipated treatment/procedures after initial examination.

A deposit is required with the authorization of each estimate in the amount of the low-end or half the high-end (whichever is greater).

If collection and/or legal actions become necessary, you are fully responsible for all incurred fees. We aim to provide our patients with superb care and service. Please excuse any delays, we will give your pet the same careful attention, at the earliest opportunity.


I hereby acknowledge the above and consent to the examination and consultation by the attending Clinician at East End Veterinary. I further understand that I am responsible for all fees, including exam, diagnostic, treatment, and/or surgical procedures, and am fully aware that this responsibility remains in the event my pet fails to recover.



 

CRITICAL CARE AUTHORIZATION FORM

If your pet is arriving to our hospital in a critical state, please carefully review and complete this form.

Complete Critical Care Authorization Form