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New Client Form

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New Client Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pets before your visit.

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Primary Owner First and Last Name *

First

Last

Primary Owner Date of Birth *

Cell Phone Number *

Primary Owner Email *

(Please provide the best email to receive information and updates on your pet’s health - ALL LAB RESULTS WILL BE COMMUNICATED VIA EMAIL)

Co-Owner First and Last Name

First

Last

Co-Owner Date of Birth

Co-Owner Cell Phone Number

Co-Owner Email Address *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Preferred Email to Receive Results *

ALL LAB RESULTS WILL BE COMMUNICATED VIA EMAIL

Emergency Contact Name *

First

Last

Phone Number *

Pet Information

Patient Name *

Breed *

Age or DOB *

Sex *

Neuter/Spay *

Additional Pet(s)

Please provide if there are any other pets in the household and their information

Previous Vet Hospitals *

Phone Number

May we post pictures of your pet(s) to social media? *

How did you hear about us? *

Camera Use Policy

I understand that Vets on the Hudson may be filming while in their building. I understand that for staff safety, I am not allowed to film while inside the building, not limited to: the lobby, exam rooms or treatment areas.

Signature of client/owner responsible for pet(s) *

Clear Signature

Pharmacy and Lab Work Policy

I understand that Vets on the Hudson only approve online prescriptions through their online pharmacy, Vets First Choice, and Chewy. If I would like to use another pharmacy, I will have to pick up a written prescription. No prescriptions will be approved over the phone or via fax. Please allow 24-48 hours for any medication or prescription preparation. I also understand that all outside laboratory work can take 5-7 business days. It is possible that lab results may not be given to me until all labs have been finalized.

Signature of client/owner responsible for pet(s) *

Clear Signature

Appointment Time Frame

Regular appointments here with Vets on the Hudson are 30 minutes. Please be considerate of our time and of others. We have a 10 minute grace period. If you are more than 10 minutes late, Vets on the Hudson holds the right to cancel or reschedule your appointment. Recheck appointments are 15 minutes. The grace period for recheck appointments is 5 minutes. Any missed appointments are subject to our cancellation policy.

Signature of client/owner responsible for pet(s) *

Clear Signature

No Touch Policy

For everyone's safety, we have a strict "no touch" policy for our clients while your pet is being treated by our doctors or staff. This helps us focus fully on your pet's care. Please note that Vets on the Hudson cannot be held responsible for any injuries sustained by owners who do not adhere to this policy.

Cancelation Policy

Field #70 (copy) *

We have a 24 hour cancellation policy for all appointments; If you need to cancel or reschedule your appointment, please allow 24 hours. If 24 hour notice is not given, you will be charged a missed appointment fee. This also applies to NO SHOWS. If you do not show for a scheduled appointment, you will be asked to give a deposit in order to schedule another appointment, as well as pay your missed appointment fee.

For all Surgeries / Dentals / Procedures - We have a 7 day cancellation policy; If you need to cancel or reschedule, please allow 7 days notice. A deposit of $400 is required at time of scheduling. If a 7 day notice is not given, your deposit will be kept and not refunded. This also applies to NO SHOWS. If you do not show for a scheduled surgery / dental / procedure, you forfeit your deposit. In order to reschedule the surgery /dental / procedure, it is required to pay the balance of your estimate at time of scheduling. **This does not apply to specialty surgeries performed by a traveling surgery specialist**

Signature of client/owner responsible for pet(s) *

Clear Signature

Authorization

I hereby authorize the veterinarian to examine, prescribe for, or treat the abovedescribed pet(s) and any other pets I have given permission to be on my account in the future. I assume full responsibility for all charges incurred in the care of the animal(s). I verified all the above information is correct. I also understand that <b>All professional fees are due at the time of services rendered and all refunds will acquire an additional 8% processing fee.</b>

Signature of client/owner responsible for pet(s) *

Clear Signature

Date *

Message

New Client Form

New Client Form

Pet Information

Camera Use Policy

Pharmacy and Lab Work Policy

Appointment Time Frame

No Touch Policy

Cancelation Policy

Authorization

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