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Sunrise Boulevard AH - New Client Information Form
  • 1
    • Individual
    • Referral
    • Hospital Sign
    • Yellow Pages
    • Website
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  • 2
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  • 3
    • Cat
    • Dog
    • Yes
    • No
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  • 4
    • Cat
    • Dog
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  • 5

    I hereby authorize Sunrise Boulevard Animal Hospital (SBAH) to examine, prescribe for, treat or perform surgery upon the above-described pet (s). I also consent to the administration of such anesthetics as are necessary. Furthermore, I agree to pay fees for services rendered at the time the pet is discharged from the clinic or when service is otherwise terminated. SBAH is authorized to humanely dispose of said animal(s) unless I, the owner, or an authorized agent of mine, calls for and pays all accrued charges on the animal(s) with 14 days after written or oral notification that the animal is ready to be released from the hospital. I further understand that the veterinary service is provided during the night time hours as necessary in the judgment of the veterinarian in charge. Continuous presence of qualified personnel may not be provided at all times.

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  • 6
    Clear
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  • 7
    Pick a Date
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