New Client New Patient Form

God's Dogs Rescue Veterinary Clinic

We like to take pictures for documenting in medical records (wounds/x-rays/etc), to text you images of before & afters/surgeries or for social media/learning purposes with our affiliated teaching hospitals.

I grant GDRVC representatives the right to take photographs of me and/or my pet, and to copyright, use and publish the same in print and/or electronically, with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising and Web content.

Signature is required before exam or treatment. I consent to and authorize GDRVC & its representatives to administer such treatment, diagnostic, surgical, and anesthetic procedures as they deem necessary. None of the above will be held liable or responsible in any manner whatsoever, under any circumstances, for the care or treatment as it is understood. I assume all risks. I hereby certify that I have read and fully understand the above authorization for medical and/or surgical treatment. I also agree that no guarantee or assurance has been made as to the results that may be obtained.  

I assume financial responsibility for all charges incurred to patient, consent to release of medical information, and authorize direct payment to GDRVC. Professional fees are to be paid at the time services are rendered. We accept debit/credit cards, cash, & CareCredit. I understand that I am financially responsible for payment of all bills for veterinary services, late charges, and collection costs.

I understand that to better support accurate medical record keeping, some appointments may be recorded using AI-assisted software. These recordings are confidential and used only for medical documentation purposes.