New Client Form

New Client Form

  • Owner Information

  • Pet Information

  • Pet Information

  • Pet Information

  • *** AUTHORIZATION ***

    I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet(s). To the best of my knowledge, I affirm the following pet(s): 1.) no known or diagnosed allergies to vaccines, 2Mission Hills Veterinary Center uses the finest vaccines available, however, a vaccine reaction is possible, but rare. 3.) Should my pet(s) become ill due to vaccine, I will not hold Mission Hills Veterinary Center or its affiliates responsible. 4.) Being aware of these facts, I give my permission to Mission Hills Veterinary Center to administer the vaccines recommended. 5.) If applicable, I will not give HEARTWORM PREVENTATIVE without NEGATIVE test results. I assume responsibility for all charges incurred in the care of the animal. I also understand that these charges will be paid at the time services are rendered. Owner agrees to pay all charges incurred as a result of any visit to or care rendered to Owner’s at Mission Hills Veterinary Center at the time said services are rendered. In the event that the said charges are not paid upon rendering services; the owner agrees to pay all costs, fees and expenses, including the reasonable attorney fees, incurred as a result to collect charges.

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