"*" indicates required fields

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Is your dog on Heartworm Prevention?*
Has your cat been tested for Leukemia and FIV?*
Is your pet Microchipped?*
Is your pet current on Vaccinations?*
List the names and ages of any other animals that you own

I assume the responsibility for all charges incurred in the care and treatment of my animal(s). I also understand that these charges will be paid at the time of release and a deposit may be required for treatment. In the event, any account is not paid when due, the prevailing party shall be entitled to recover its reasonable attorney fees and any court costs, including costs of appeal or another review. In the event that your account is placed for collection with a collection agency, you agree to pay any collection fees that may be assessed in addition to the amounts owing.

Photo Release Form

Permission to Use Photograph

I grant to Family Pet Heath Care, its representatives and employees the right to take photographs of me, my pet(s) and my property in connection with the above identified subject. I authorize Family Pet Health Care, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Family Pet Health Care may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

Printed name
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This field is for validation purposes and should be left unchanged.