CLIENT MEDICAL REGISTRATION FORM

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I hereby authorize Roosevelt Station Vet Care (RSVC) to perform medical and initial diagnostic/surgical procedures on this animal as required for  diagnosis and treatment. I understand that I can terminate treatment at any time by contacting the doctors and medical team. 

RSVC and it’s staff are leaders and teachers in the veterinary medicine field, thus case information and/or photos may be used in teaching forms  and continuing education, website/social media, veterinary literature, and the like. I authorize the release of case/patient information for such  purposes. 

Payment is due as services are rendered. The balance is due upon dismissal from the hospital. Payments can be made by cash, personal check  (with proper identification), and accepted credit cards, including Care Credit. If payment arrangements are needed, the undersigned realizes that they must be agreed upon prior to admitting patients. In order to avoid misunderstandings, please let us know immediately if these terms  are not satisfactory. In the event that I sell this animal to another owner, I authorize release of medical information to the new owner. 

Please type your full name to indicate that you have read the above authorizations and policies.