Human Registration Form

Save time during your next appointment. Complete your human registration form online from any device at any time before your visit.
Two young German Shorthaired Pointer puppies

Human Registration 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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(Required by the DEA for prescriptions)
MAILING ADDRESS:
(text reminders):
(for prescriptions)

I, the undersigned owner of the pets on my account, give permission for the above emergency contact(s) to authorize care for my pets, if I cannot be contacted. Should unexpected life-saving emergency care be required, and my attending veterinarian is unable to reach me, Antelope Veterinary Clinic has my permission to provide such treatment and I agree to pay for such care.

I, the undersigned owner of the pets on my account, certify that I am over eighteen years of age and thereby consent to the examination and care of my pet by the Veterinarians and staff at Antelope Veterinary Clinic, and after consultation with me, prescribe medications, treat, hospitalize, anesthetize and/or perform surgery on my pet, and or take medical photographs for documentation. I understand that there are always some risks present in medical treatment and that I should discuss my concerns with my attending veterinarian before treatment is initiated.

I understand that all payment is due at the time of service, and Antelope Veterinary Clinic does not accept payments. I understand that I have the right to request an estimate prior to any treatment being provided and that the staff will be happy to provide me with one.

I further understand that a deposit may be required for surgical treatment or hospitalization of my pet. Should my pet be hospitalized at Antelope Veterinary Clinic, I understand that 24-hour supervision of my pet is not available and there is no staff available after hours.

Antelope Veterinary Clinic may take photos of my pet for social media.
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