Urgent Care Client/Patient Information

START NOW

Urgent Care Client/Patient Information
Form

Please complete our Urgent Care Client/Patient Form. All fields marked with * are required and must be filled.

The following individual(s) is designated as alternate to give consent for services in my absence. The designation remains in place until the hospital is otherwise notified. As the owner, you are still responsible for any charges incurred by the consent given by the alternate individual.

NOTE: For the safety of all animals here, it is our policy that all animals be up to date with their vaccinations in order to be hospitalized or boarded.

Patient 1:

If you currently have a primary veterinarian, Pittsford Animal Hospital will not see your pet(s) for wellness and follow-up care. It is Animal Urgent Care’s policy not to accept any patients that are seen during urgent care hours as long-term general practice patients. I, the undersigned, am at least 18 years of age and hereby state that I am the owner/caregiver of the above-specified animals.

In the event that payment is not received and my account is placed for collection, I agree to pay service charges in the amount of 1.5% per month (18% per annum) in addition to the amount.

Shop Our Online Store