New Patient Form

If we were to take a picture of your pet we would like your permission to use it in our social media content, promotional materials and/or publicity efforts. These photographs may be used in publications, print ads, direct-mail pieces, electronic media (e.g. video, Internet, Web site) or other forms of promotion in perpetuity without remuneration or further consent. Your pet’s name may be shared but your identifying information would not be.

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Glendale Veterinary Hospital to release patient information to the primary care hospital or veterinarian.

By submitting this form, I hereby authorize Glendale Veterinary Hospital to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Glendale Veterinary Hospital.