Returning Client Registration

Homer Veterinary Clinic PC

326 Woodside Avenue
Homer, AK 99603

(907)235-8960

www.homervet.com

Returning Client Registration

Owner/Spouse name

Owner/Spouse phone

Additional Phone

Physical Address
Street Address
City
,
State / Province
Zip / Postal Code
Mailing Address (if different than physical)
Street Address
City
,
State / Province
Zip / Postal Code
Email

Please list all of your current pets (include name/species/concerns)

Please provide information for any new pets

Are there any additional details you would like us to know about your pets?

Authorization:
I am the owner of the animal(s) named above or am responsible for him/her/them and have authorization to execute this consent. I hereby authorize the diagnosis and treatment of this(ese) animal(s) and the performance of such surgical or therapeutic procedures determined to be indicated and the use of drugs/anesthetics/devices deemed advisable by the veterinarian staff. Payment is due at the time of service. Cash, check (exception health certificates), Visa, Mastercard, Discover, American Express and Care Credit are all accepted. A 1.5% per month service charge is applied to all unpaid accounts. A pet is considered abandoned if, within 5 days of written notice to do so, the pet is not claimed nor alternative arrangements made with clinic staff. If abandoned, the clinic may rehome or, if deemed medically necessary, euthanize the pet and fees for services provided caring for the pet will still be payable.
Agree with the conditional statement above
Yes
No

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