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Registration Form

  • Client Information

  • MM slash DD slash YYYY
  • Spouse / Partner Information

    If applicable
  • MM slash DD slash YYYY
  • Pet Information

  • Owner’s Responsibility

  • Payment is required for all services at the time they are rendered unless prior arrangements have been made with hospital management. In the event that a refund is due and the original payment is a credit card, the refund will be posted against the original credit card. All returned checks are subject to a $25.00 service fee. A 90-day old account balance is subject for collection efforts and a $25.00 collection fee will be assessed. Your signature below signifies your understanding and willingness to comply with the hospital’s payment terms. In some cases, a deposit may be required before proceeding.

    Veterinary Consent: I authorize Erickson Veterinary Hospital to perform the treatment/procedure(s) described in my pet’s chart. I will be informed of the reasons for the treatment/procedure(s), along with the expected benefits and risks involved. I understand that unforeseen conditions may require an extension of a planned procedure and/or surgery. I hereby authorize the performance of such procedures or surgeries as are necessary and advisable in the professional judgment of EVH veterinarians or a relief veterinarian. I understand that I assume all risks and am responsible for all costs involved. I also authorize EVH to use pictures of my pet(s) for promotional purposes. Consent will apply to all future pets added to this account unless and until I provide a written revocation of that consent.

    Missed/Cancellation Fee: A fee of $50 will be assessed on your client account if you fail to show up for an appointment without an email or phone call or cancel without at least a 24 hour notice.

    Surgical Appointment, No Show Policy A $100 charge will be charged for any missed/cancelled surgical appointment without at least a 24 hour notice. This applies for dental procedures as well.

Please make sure that when you arrive at our hospital that you have your pets on their leash for their safety. Sorry for the inconvenience of the loud noises due to construction as we work to expand our hospital and services.

Please arrive early due to limited parking. Thank you for your understanding.