Skip to Content

New Client/Patient Registration

Address
Best method for contacting you
Please select any problems and list any symptoms that you have noticed or concerns you have regarding your pet:

Photo/video release: I, the undersigned, hereby grant Switzerland Animal Hospital permission to use, reuse, publish, and broadcast in any and all media photographs or video footage taken of me or my pet in which I may be included with others. I release Switzerland Animal Hospital from any demands arising out of the use of photographs, video, and audio material including without limitation, all claims for libel or invasion of privacy. I am of full age and contract in my own name.

Photo/Video Release
How did you hear about our hospital?

Additionally, the right of confidentiality belongs to you, our client. We cannot release information about you or your pet (our patient) or the care of your pet unless you provide authorization or waive that right.

Please select one of the following statements:

Authorization – I hereby authorize the veterinarian to examine, prescribe for, or treat the above described pet. I assume responsibility for all charges incurred in the care of this animal. I also understand that these charges will be paid at the time of release and that a deposit may be required for treatment.

I, the undersigned, hereby grant Switzerland Animal Hospital permission to use, reuse, publish, and broadcast in any and all media photographs or video footage taken of me or my pet in which I may be included with others. I release Switzerland Animal Hospital from any demands arising out of the use of photographs, videos, and audio materials including without limitation, all claims for libel or invasion of privacy. I am of full age and contract in my own name.

Sign above
Back to top