New Patient Registration Form

CONTACT INFORMATION

PET HEALTH HISTORY

Vaccination History *




AUTHORIZATION

PROFESSIONAL FEES ARE TO BE PAID AT THE TIME SERVICES ARE PERFORMED. In admitting my pet(s) for diagnostic, treatment, or surgery, I authorize the veterinarians of Deer Park Pet Hospital, and their support staff, to perform such treatment and/or perform such diagnostic or surgical procedures as deemed necessary. It is understood that an estimate of charges will be given for services at the clientโ€™s request. No guarantee or assurance can be made as to the results that may be obtained. I understand that a deposit of 50% may be required before services are performed and I assume full financial responsibility for all charges incurred by my pet. I realize that these charges may exceed a given estimate if complications arise. I understand that I will be contacted prior to treatment, if possible, should complications occur.

 

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