MCKNIGHT VETERINARY HOSPITAL IS NOW FOCUSING ON PREVENTATIVE CARE AS A GENERAL PRACTICE.

Client Registration Form

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

 

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). Click on each header to expand the section.

 

PET INFORMATION

Has your pet been vaccinated?

CURRENT CONDITION

Eating / Drinking normally? *
Vomiting? *
Diarrhea? *
Coughing? *
Sneezing? *

PRIMARY & SECONDARY CONTACTS

PLEASE NOTE: WE ACCEPT MEDICAL DIRECTIVES FROM SECONDARY CONTACTS THAT HAVE BEEN ENTERED INTO OUR SYSTEM. INFORMATION REGARDING YOUR PETS CAN ONLY BE RELEASED TO INDIVIDUALS AS OWNERS ON FILE. PLEASE ADVISE OUR RECEPTION IF YOU WOULD LIKE TO ADD ADDITIONAL NAMES.
 

CONSENT FOR EMAIL COMMUNICATION

I agree to allow McKnight Veterinary Hospital (MVH) to contact me via email regarding my pet, including but not limited to appointment reminders, diagnostic test results and information that may affect the health and wellbeing of my pet, such as drug or pet food recalls. I may withdraw my consent at any time by contacting MVH in writing.

 

In accordance with the Privacy Act, I understand my rights for privacy and that personal information will not be released without my consent. I consent and authorize the disclosure of necessary personal and medical information required for the ongoing veterinary care of my pet, when communicating with other veterinarians, specialists and other relevant third parties.

Please indicate if you agree with the above statement: *

PHOTO/VIDEO RELEASE

McKnight Veterinary Hospital (MVH) enjoys sharing our patient’s photos and stories within our hospital and online. We would love your permission to share your pet’s image and story. Sharing stories is a fun way to assist us in educating other pet owners about pet health.

 

Please note: photos and/or video recordings may be required to document your pet’s medical condition, and therefore may be used as an important aspect of your pet’s legal medical record. This release refers to public use of photos/video recordings only.

 

Help us by reviewing the statement’s below:

 

I grant MVH, its representatives, and employees the right to take photos/video recordings of my pet, and to copyright, use, or publish my pet and my pets story in print and/or electronically including, but not limited to social media, publicity, advertising, online content, and for client education purposes.

Please state if you agree/disagree with the above statement *

I understand that MVH is not responsible for any expense or liability incurred as a result of my pet(s) participation in any photos and/or video recordings.

 

I may withdraw my consent at any time by contacting McKnight Veterinary Hospital in writing.
 

ACKNOWLEDGMENT REGARDING PAYMENT

I understand full payment is due at the time services are rendered. If I am unable to pay in full, I must notify MVH immediately prior to treatment. Should my pet be hospitalized, I will receive an itemized treatment plan. I understand I must leave a deposit of the high end of the listed amount on the treatment plan. Accepted payment forms are cash, credit card, (MasterCard and Visa) and debit card.
 

Please verify that you are human *