New Patient Form

Animal Information

Owner's Name:

Color or Markings:

Previous veterinarian where records could be obtained if necessary:

My pet lives:
Inside OnlyOutside OnlyInside and Outside

What does your pet’s diet consist of?

Please mark if your pet has:

Statement of Ownership and consent By signing this document I confirm that the above information is correct. I also confirm that I am the owner of the above-described animal, or have written authorization from the owner to consent to treatment from Mill Creek Veterinary Hospital. I hereby authorize the performance of professionally accepted diagnostic, therapeutic, anesthetic, and surgical procedures necessary for its treatment. To prevent the spread of infectious disease and parasites, hospitalized animals must be current on all vaccines, free of internal and external parasites. I authorize the treatment of vaccines and parasite control as needed for my animal. I accept financial responsibility for all services incurred. I also understand that charges will be paid at the time of service.