New Patient Form

Thank you for visiting our hospital. We look forward to getting to know you and your pet. Please help us to provide the best care possible for your pet by taking a moment to fill out this form.

Client / Owner Information
Spouse / Co-Owner Information
How did you hear about us?
Doctor Referral
If you have been referred to us by another veterinarian, please provide their information below.
Please tell us about your pet(s)
Vaccination Dates
Please tell us about your pet(s)

I certify that I am the legal owner or authorized agent of the animal listed above. I am at least (18) years of age and I assume total financial responsibility for the costs of services rendered by Metropolitan Veterinary Center as well as responsibility for the decisions regarding care and treatment of the animal(s) described herein. I understand that full payment is required at the time services are provided. I understand that upon my request the hospital staff will provide an estimate of any current and / or anticipated charges. By signing below, I am authorizing veterinary care be provided for the above described pet, presented by me or by my directed agent(s) to Metropolitan Veterinary Center. I understand that veterinary care may include, but is not limited to, examination, prescription or administration of medication or medical treatment including surgery.

I authorize the staff of Metropolitan Veterinary Center to use photographs of this pet for promotional purposes including but not limited to brochures, their website and social media sites such as Yelp and Facebook.

And to the best of my knowledge the above information is accurate.