New Patient Intake Form

* If your pet has a medical emergency, phone your nearest emergency pet hospital.

New Client Intake Form
Address *
Primary Phone Type *
Co-Owner Primary Phone Type

Text & Email Notifications

We can notify you of upcoming appointments, medication refills and annual check-ups.

Text & Email Notifications *

Patient Information

Have more than one pet? Click the "Add" button to provide information on your whole four-legged family.

Pet Number 1

If mixed breed, what does your pet most resemble?
Please include the name, dose, and frequency of the drug/supplement (e.g. Carprofen 25mg every 12 hours)
Please select all that apply
Please select all that apply
Is your pet current on rabies vaccination *
Do you have verification of rabies vaccination for your pet? *

Photography Consent

We adore our patients, and love to share photos and stories about the wonderful pets we see every day.

May we feature your pet too?

I hereby grant to River Valley Veterinary Hospital, its representatives and employees, the right to take photographs of me and/or my pet, and to copyright, use and publish the same in print and/or electronically.

I agree that River Valley Veterinary Hospital may use such photographs of me and/or my pet with or without my name for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content.

Authorization: *

Authorization For Treatment

Please Read & Agree To This Authorization For Treatment

I hereby authorize the staff of River Valley Veterinary Hospital to render any treatment that is deemed necessary to my pet(s) health while in custody of the hospital. I understand that in the event of any unusual or emergency circumstances, the staff will make every attempt to contact me or my designated representative before, if time permits, proceeding with treatment. I understand that I will be financially responsible for all emergency procedures including the Estimate of Charges provided to me in person or over the telephone.

I understand that professional fees are to be paid at the time services are rendered and a deposit is required on all pets admitted to the hospital.

I Have Read And Agree To The Authorization For Treatment *