New Patient Registration Form


























  • MM slash DD slash YYYY








  • Co-owner's Name & Contact #




















  • Pet Information

  • (if adopted from Woof Gang Rescue)



  • MM slash DD slash YYYY









  • Photo Consent

    We love social media! Do we have your permission to share your pet(s)’ image/video/story on social media, our website & other forms of related media? Your name and personal information will never be shared.


  • Pet Health Savings Plan



  • Treatment Consent

    Upon signing this agreement, I certify I am the Owner/Authorized Agent of above pet(s) and have authorization to consent to treatment if and when needed. I authorize AVH to examine, prescribe for and/or treat the above pets. I recognize that financial concerns should be discussed PRIOR to exam & treatment. I understand I am entitled to ask for and be provided with a written estimate of fees regarding services and/or products prior to services being performed. I assume full responsibility for all charges incurred and understand these incurred charges are to be paid, IN FULL, at the time the services are rendered. (Accepted payment methods: Cash, Credit Card (Visa, Mastercard, Discover, American Express), Check (DL # required) and Care Credit.)