Art City Vets: New Client/Patient Form
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  • New Client/Patient Form

    Please complete this form prior to arrival if possible!

  • Client Information

  • Are you a new or existing client?*
  • I am the*

  • If you are NOT the owner of the patient being seen today, we will need verbal authorization from the owner before we can begin services. Please provide the following:

  • Would you like to Authorize a secondary contact on the account?*
  • Do you have a primary care vet?*
  • Would you like Art City Vets to be your primary care veterinarian?

  • https://www.artcityvets.com/our-care-policy

  • Patient Information

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  • Authorization

  • Pet Photo/Video Consent: I hereby grant Art City Vets & Urgent Care permission to use any photographs or video taken of myself or my pet, in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree that these materials will become your property and will not be returned. I hereby authorize to edit, alter, copy, exhibit, publish or distribute this photo or video for purposes of publicizing your programs or for any other lawful purpose. In addition, I waive any right to royalties or other compensation arising or related to the use of the photograph or video footage. I hereby release rights to all claims, demands, and causes to action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf of my estate have or may have by reason of this authorization. In signing this consent, I give authorization to use my name and my pet’s name and information as printed below.*

  • We appreciate you entrusting us with the care of your pet. We understand that having a sick pet is often an emotional time. The best veterinary-client relationships are based on trust, communication and mutual respect. We want what is best for your pet! We will treat you and your pet with kindness, and ask that you do the same to our team. Abusive language, threats, as well as racist, sexist or homophobic language will not be tolerated. Please let us know if you have any concerns or questions.

  • Date*
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