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New Clients
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Online Pharmacy

Home
About Us
Our Services
Engagement

Resources
Forms
New Clients
- Expectations of our Clients
- New Client Registration
Online Pharmacy

Feeding Pets of the Homeless Wellness Clinic: Sat, Oct 11th.

775-246-5392 | info@myriverside.vet | Contact

Home
About Us
Our Services
Engagement
Resources
Forms
- New Client Registration
- Expectations of our Clients
New Clients
Online Pharmacy
Appointments

Home
About Us
Our Services
Engagement
Resources
Forms
- New Client Registration
- Expectations of our Clients
New Clients
Online Pharmacy
Appointments

New Version – new Client Form Registration

Client Information

Owner's Name(Required)

First Last

Co-owner's Name

First Last

Street Address(Required)

Street Address Address Line 2 City State ZIP Code

Contact Info

Phone(Required)

Co-Owner Phone

Email(Required)

Additional Contact

Additional Contact Name

First Last

Additional Contact Phone

Employer

Employer Name(Required)

First Last

Employer Phone(Required)

Are you 18 years of age or older?

Yes

No

Patient Information

Name(Required)

Species(Required)

Breed(Required)

Color(Required)

Age(Required)

Sex(Required)

Male

Female

Altered (spayed/neutered)(Required)

Yes

No

Previous Medical History?

Has your pet previously been fearful or aggressive at the vet?(Required)

Yes

No

Please explain(Required)

Vaccines Current?(Required)

Yes

No

Current Rabies vaccination is a requirement for treatment

Current Medications?

Authorization

As the owner, or a duly authorized agent of the owner, of the above-named animal, I hereby consent and authorize Riverside Veterinary Hospital (RVH) to receive, examine, prescribe, treat and operate on this animal. I also assume all charges incurred in the care of this animal. RVH does not offer 24-hour care. If my animal were to stay overnight, I understand there would be no monitoring. All animals must be picked up on the same business day as admission unless other arrangements have been made. If a patient is not collected within 24 hours, then a written notice will be sent to the address above. Three (3) days after such written notice, the animal will be considered abandoned and will be the property of RVH. It is understood that abandonment does not relieve me from the responsibility of payment for services rendered. Hospital Policy: Payment is due in full at the time services are rendered. Checks are not accepted.(Required)

I authorize and consent

Treatment Plans/ Estimates

I understand that charges accrued will be within 30% of the treatment plan/ estimate provided*. If charges will be greater than 30% more than my estimate, a member of staff will contact me for authorization before continuing. *except in the case of cardiopulmonary arrest (CPR).(Required)

I understand the above

Training and Education

We believe in sharing information and developing both the next generation and keeping our staff fresh and up to date: through contact and exchange via education. Therefore veterinary externs, veterinary students, and veterinary technicians in training may all be present and participating in the care of your animal under the supervision of our licensed practitioners.(Required)

I have read & understand

Extra-label Drug Use

I hereby acknowledge that I have been informed that many medications utilized by RVH are not labeled for use in dogs/cats/exotics. Although these medications have been used previously, no guarantee of efficacy has been made and potential side effects are not fully known at this time. I give permission to use these medications in my pet and agree to follow the prescribed protocol and allow re-examination of my animal as deemed necessary by the veterinarians.(Required)

I acknowledge

Social Media

I authorize RVH to take photos of my pet(s) and use them for any lawful purpose, including training, publicity, illustration, advertising, and web/social media content.(Required)

I authorize and consent

RVH Cancelation Policy

It is the policy of the hospital to monitor and manage appointment no-shows, late arrivals, and late cancellations. Our goal is to provide excellent care to each patient in a timely manner. If it is necessary to cancel an appointment, clients are required to call or leave a message at least 24 hours before their scheduled appointment time. Those who have left a deposit to reserve their appointment will forego any refund if cancellation is not confirmed 24 hours ahead of time, or violation of the “late arrival” or “no show” policy. Notification allows the practice to better utilize appointments for other patients in need of prompt veterinary care.(Required)

I understand

RVH Late Policy

As a courtesy to others, Riverside Veterinary reserves the right to reschedule your appointment if you are more than 5 (five) minutes late.(Required)

I understand

Client Code of Conduct

Be kind & considerate. We will endeavor to have the most generous interpretation for your behavior & we expect the same from you. Be on-time… see our late policy. No -isms, -phobias, or bigotry of any kind. No hate speech or bullying, no profanities or vulgar language.(Required)

I have read and understand

Transfer of Medical Records

I, the owner/agent, give permission for my pet's medical records to be sent/transmitted to any other veterinary professional or clinic. I also give permission to transfer records to any veterinary insurance provider if requested.(Required)

I give permission

Signature(Required)

Date(Required)

MM slash DD slash YYYY

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Riverside Veterinary is Welcoming New Clients to Join our Family

Come visit us today

210 Dayton Valley Rd.
Dayton, NV 89403

(775) 246-5392
info@myriverside.vet

Mon-Fri: 8:00am - 5:00pm
Sat-Sun: Closed

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