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Pet's Name: blanks* Birthdate Date Species: Dog Cat Bird Reptile Small Mammal Other* Breed: Breed* Color: Color* Sex: Male Female* Neutered/Spayed: Yes No Unsure* What was the age of the pet when it was obtained? * Pet's Diet: * At what hospital or adoption agency may we find previous records? * It is the policy of Animal Ark not to release ANY information concerning your pet to boarding, grooming, other veterinary facilities and animal adoption agencies without your permission. By signing below, you give us permission to release pet information to, or request information from, the above entities ONLY.Signature* Date*
I hereby authorized the veterinarian to examine, prescribe for, or treat, the above described pet. I assume full responsibility for all charges incurred in the care of this pet. ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. In cases of extensive medical or surgical procedures where full payment may be difficult at discharge, we accept Pet Insurance, Visa/Mastercard, Discover, Debit and Care Credit cards. There will be a service charge of $10.00 for any check returned unpaid.Signature of Client Responsible for Pet(s) Signature* Date* *We have a large social media following and share real photos and videos of a variety of treatments, procedures, events, random cuteness and everyday veterinary medicine. Please sign acknowledging that you are aware that there may be photos or videos taken of your pet, or that you have submitted to us, used for social media engagement and educational purposes by Animal Ark Veterinary Hospital's social media platforms. Signature* Date