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Owner's Information

Pet's Information

Second Pet

Third Pet

I give permission for my pet's name and image to be used for education, children's workshops and social media/ marketing purposes. I authorize Advanced Veterinary Care of San Elijo to examine, prescribe for, and treat the above pet(s) and additional pet(s) in the future. You will receive an estimated cost of treatments prior to them being performed. Payment is due at the time of service. For surgery or admit appointments, a deposit may be required before leaving the hospital. Emergency patients may require lifesaving treatments before the estimate is completed.

Please enter full name of either primary or co-owner.

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