Art City Vets: New Client/Patient Form

Patient Information
How many pets would you like to add?

Where can we contact to obtain this pet's history or medical records?
Please list all previous hospitals, rescues, and/or shelters
Please upload any previous records:

Browse Files

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How is this pet's anxiety level while at the vet or generally with handling?
Is there anything you'd like us to know about this pet that may reduce their anxiety?

Where can we contact to obtain this pet's history or medical records?
Please list all previous hospitals, rescues, and/or shelters
Please upload any previous records:

Browse Files

Cancelof
How is this pet's anxiety level while at the vet or generally with handling?
Is there anything you'd like us to know about this pet that may reduce their anxiety?

Where can we contact to obtain this pet's history or medical records?
Please list all previous hospitals, rescues, and/or shelters
Please upload any previous records:

Browse Files

Cancelof
How is this pet's anxiety level while at the vet or generally with handling?
Is there anything you'd like us to know about this pet that may reduce their anxiety?

Where can we contact to obtain this pet's history or medical records?
Please list all previous hospitals, rescues, and/or shelters
Please upload any previous records:

Browse Files

Cancelof
How is this pet's anxiety level while at the vet or generally with handling?
Is there anything you'd like us to know about this pet that may reduce their anxiety?

Where can we contact to obtain this pet's history or medical records?
Please list all previous hospitals, rescues, and/or shelters
Please upload any previous records:

Browse Files

Cancelof
How is this pet's anxiety level while at the vet or generally with handling?
Is there anything you'd like us to know about this pet that may reduce their anxiety?

Where can we contact to obtain this pet's history or medical records?
Please list all previous hospitals, rescues, and/or shelters
Please upload any previous records:

Browse Files

Cancelof
How is this pet's anxiety level while at the vet or generally with handling?
Is there anything you'd like us to know about this pet that may reduce their anxiety?

Authorization
I acknowledge that Art City Vets may release medical records to another veterinary hospital when requested or upon referral. If an insurance company is listed for a pet, Art City Vets will send records to that company following each visit.*

Yes
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.*

YesNo
Instagram username (Optional)
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.
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New Client/Patient Form

Client Information

Patient Information

Authorization