REVS New Client Consent Form

New Client Consent Form

Please complete before our visit with you.
Client Full Name*

First NameLast Name
Horse Details*
Please list horse name(s), breed, age, colour
Client Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this the horse(s) location?*

YESNO
Horse(s) Location

Property/ Agistment Name

Street Address

CityState / Province

Postal / Zip Code
Client Email Address*
example@example.com
Client Phone Number*
Please type your phone number here.
Declaration

By submitting this form, I request and authorise Riverina Equine Veterinary Services to examine, treat, and perform veterinary procedures on the animal(s) under my care. I understand that veterinary treatment may involve risks and that outcomes cannot be guaranteed.

I consent to veterinary examinations, treatments, procedures, and the administration of medications as considered necessary or appropriate by the attending veterinarian.

I also consent to emergency treatment where, in the veterinarian’s reasonable opinion, immediate action is required to protect the animal’s welfare and it is not practical to obtain further consent.

I understand and agree that payment is due within 7 days of the invoice date, unless an alternative arrangement has been agreed prior to treatment.

Overdue accounts may incur a monthly late fee.
All debt recovery costs, including legal and collection agency fees, will be payable by me.
Interest may be charged on overdue amounts.
Non-urgent services may be withheld if my account is overdue, where permitted by law.

I acknowledge that the full Terms and Conditions are available on the Riverina Equine Veterinary Services website.
I am the owner and/or authorised agent of the above named horse(s)I have read, understand, and agree to the above consent and payment terms
Client Signature*

Clear
Should be Empty: