New Patient Registration

Authorization

I certify that I am over 18 years of age and the owner or authorized agent for the owner of the above pet. I hereby authorize Rainbow Veterinary Hospital to examine, treat and prescribe for this pet. I consent to the release of previous medical history. I assume financial responsibility for all charges incurred for care and understand that:

FULL PAYMENT IS DUE AT THE TIME SERVICES ARE RENDERED.
A DEPOSIT IS REQUIRED FOR HOSPITALIZATION and/or SURGICAL TREATMENT.