Name *

First

Last

Primary Phone *

Please enter a valid phone number.

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

How did you hear about us? *

Name of Spouse or Other Contact

Cell Phone

If different than primary phone.

Is it OK to Text Cell Phone? *

Yes
No

Spouse's Phone

Please enter a valid phone number.

Is it OK to Text Spouse Phone?

Yes
No

Alt Phone

Please enter a valid phone number.

I consent to have photos of my pet posted on the company’s Facebook Page and Instagram*

Pet Information

Pet's Name *

Pet's Breed *

Pet's Color *

Pet's Age or Date of Birth *

If unsure, indicate as “listed in records"

Pet's Sex *

Male
Female

Is your pet spayed or neutered? *

Yes
No

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Would you like to add another pet? *

Yes
No

Pet's Name *

Pet's Breed *

Pet's Color *

Pet's Age or Date of Birth *

If unsure, indicate as “listed in records"

Pet's Sex *

Male
Female

Is your pet spayed or neutered *

Yes
No

Payment Policy

Payment is due in full at the time services are rendered. We accept cash, checks, all major credit cards, and CareCredit. A $30 service charge will apply to any returned checks.

For hospitalized patients, care cannot begin until you have confirmed your authorization by signing the client consent and estimate form and leaving an initial deposit of 50% of the upper end of the estimate. We do not extend credit or bill for services, and any unpaid invoices will be sent to collections after 45 days unless prior arrangements are made.

I have read and understand the above statements and agree to all terms therein.

Accept Payment Policy *

I have read and accept the financial policy.

Signature *

Clear Signature

Date *

Authorization for Medical Treatment

Owner's Name *

First

Last

Pet’s Name *

Medical Treatment(s) to be performed

I, the undersigned owner or agent of the owner of the pet identified above, certify that:

I authorize the veterinarian(s) at River Run Animal Hospital to perform the above procedure(s).
I agree that after consultation, the hospital’s doctors may prescribe medication for, treat, hospitalize, sedate, anesthetize, and/or perform surgery on my pet.
I understand the risks of anesthesia and/or surgery and have had the opportunity to discuss them with the attending veterinarian.
My signature indicates that all questions regarding procedures, risks, recovery, costs, and follow-up care have been answered to my satisfaction.

I understand that:

An estimate of veterinary service costs will be provided.
A 50% deposit may be required for hospitalization.
I am responsible for calling the hospital daily if my pet is hospitalized for over 24 hours.
Veterinary medicine is not an exact science, and no guarantee of results can be made.
Should unexpected life-saving emergency care be required and the hospital staff is unable to reach me*

I also understand that veterinary care during nighttime hours and weekends is provided at the discretion of the attending veterinarian, and continuous presence of personnel may not be available.

I have read and fully understand the terms and conditions set forth above.

New Client Form

Streamline Your First Visit

Pet Information

Payment Policy

Payment Policy

Authorization for Medical Treatment

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