New Patient Registration Form
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  • New Patient Registration Form

    WELCOME! Thank you for the opportunity to care for your pet and for taking the time to fill out this form.
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  • Pet Information

    Please complete an electronic form for each pet

  • Treatment Authorization & Payment Policy

  • I hereby authorize the veterinarians of Atlantic Veterinary Hospital to examine, treat, and prescribe for my pet, described above.

    I understand the following:

    • I certify that I am at least 18 years old and the legal owner or guardian of the pet(s) described below.
    • I am responsible for all charges involved in the care of my pet(s) and agree to make payment in full at the time of service. I will pay by cash, check, Visa, MasterCard, or Discovery.
    • At my request, a Treatment Plan with the estimated cost for care will be provided for my approval.
    • I may request complimentary assistance in completing pet insurance refund claims; however, I am responsible for the relationship with my pet insurance company.
    • A $35 fee will be charged on all returned checks; a fee of $3 plus an interest charge of 1.5% will be added each month to all outstanding balances older than 30 days; and if my account is more than 90 days past due, I understand that my information will be submitted to a bill collection agency, which may adversely affect my credit rating.
    • Please be informed that audio recordings may be used during your pet's examination for medical record-keeping purposes. If you prefer not to be recorded, kindly let us know prior to the exam
    • Just as I expect to be treated with respect and kindness, I agree to treat the staff and doctors of Atlantic Veterinary Hospital with civility and respect at all times.

  • I certify that the information I have provided above is complete and correct.

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