New Client Form

How did you hear about us?* Hospital SignHospital WebsiteAdvertisementReferralFacebook

What are your expectations of our practice and staff members:*

Pet’s Health History

Pet’s Name*

Birthdate*

Previous Vet*

Breed*

color*

Species* CanineFelineOther

Has your pet been neutered or spayed?* YesNo

Any allergies or reactions to medications/vaccines:*

Any medications or supplements:*

Has your cat been declawed? * YesNo

Please list any other pets you have at home (excluding reptiles, equine and avian) :*

Authorization

Photo Release Form

I grant SEVERN RIVER ANIMAL HOSPITAL, its representatives and employees the right to take photographs of me and/or my pet, and to copyright, use and publish the same in print and/or electronically.

I agree that SEVERN RIVER ANIMAL HOSPITAL may use such photographs of me and/or my pet with or without my name for any lawful purpose, including such purposes as publicity, illustration, advertising and Web Content.

I approve the use of the photos of me and/or my pet.I DO NOT approve the use of photos of me and/or my pet.

I hereby declare that the information provided above is true and accurate to the best of my knowledge. By checking this box, I digitally sign this document and acknowledge that my electronic signature carries the same legal weight as my handwritten signature.

Welcome

Registration

Pet’s Health History

Authorization

Photo Release Form