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  • Thank you for giving us the opportunity to care for your pet(s).

    So that we may become better acquainted, please complete the following:

  • DATE
     / /

  • Client Information

  • Format: (000) 000-0000.
  • Is this phone able to receive text messages?
  • Format: (000) 000-0000.
  • Is this phone able to receive text messages?
  • Format: (000) 000-0000.

  • Pet Information

  • Is this animal spayed or neutered?
  • Species:
  • Are there any special considerations we should know about for this animal?
  • Does this pet have any prior vet/adoption records?

  • You have indicated that your pet came with vaccination records from the adoption agency/breeder. Please send images of all of the records. You can text images to our main number, (716) 592-7387. You can also email them to sgndvm459@gmail.com or fax them to (716)-592-9039. All records do need to be received, along with this form, in order to schedule your first appointment.

  • Please request all applicable vaccination information. Exam notes, x-rays and blood work from the lost six months should be included in records. They can emailed to sgndvm459@gmail.com or faxed to (716)-592-9039. All records do need to be received, along with this form, in order to schedule your first appointment.

  • Owner's Date of Birth:
     - -

  • Photo and Video Consent & Release – Nachbar Veterinary Hospital

    At our veterinary hospital, we believe every pet has a story worth sharing. With the permission of each pet's owner, we share patient stories and photos on social media to celebrate the strength of our patients, the bond they share with their families, and the compassionate care provided by our team. These stories help educate, inspire, and connect our community while highlighting the positive impact of veterinary medicine. By sharing these special moments, we hope to celebrate our patients, support fellow pet owners, and showcase the dedication behind every wag, purr, and recovery. By signing below, I authorize Nachbar Veterinary Hospital, its employees, agents, and representatives to photograph, videotape, and otherwise record my pet(s), and to use these images and recordings for lawful business purposes, including but not limited to: clinic's website, social media platforms, printed marketing and promotional materials, educational materials, newsletters and advertisements, displays within the clinic.
  • Please make a selection below:

  • I understand and agree that: 1. I am the legal owner or authorized agent of the pet(s) identified below and have the authority to grant this permission. 2. I grant this permission voluntarily and without restriction as to time or geographic location unless I revoke it in writing for future uses. 3. I understand that I will not receive any royalties, compensation, or other payment for the use of my pet's photograph, video, or likeness. 4. I acknowledge that all photographs, videos, and other recordings remain the sole property of Nachbar Veterinary Hospital, which retains all rights, title, and interest in such materials. 5. I release and hold harmless Nachbar Veterinary Hospital, its veterinarians, employees, agents, successors, and assigns from any claims, demands, or liability arising out of or related to the use of my pet's image or likeness, including claims involving privacy, publicity, or copyright. 6. This authorization does not permit the clinic to disclose my confidential personal or my pet's medical information without my separate authorization or as otherwise permitted by applicable law.
  • Todays Date:
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