New Client Form

New Client Form
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Would you like to receive text updates for your pet’s diagnostics, treatments, procedures, upcoming appointments, hospitalization updates, and/or to let you know when your pet’s medications are ready for pick up?

By providing your primary care doctor's information, we can share your pet's medical information with them.

Do you have pet insurance?

By submitting your insurance information, you are authorizing us to send all MRs, invoices or any requests to the insurance company.

I certify that I am 18 years and older. I hereby authorize Irvine Valley Veterinary Hospital to provide medical services to my pet(s).
I agree to pay for all services before services are initiated. All services, including life saving treatments, may be withheld until payment is received.
In order to foster mutual trust, respect, and cooperation in meeting the health care needs of my pet(s), I agree to the following responsibilities while my pet is under the medical care and direction of doctors and staff at IVVH:
I agree to ask questions or acknowledge when I do not understand the treatment course or care decision.
To diligently follow the treatment and discharge plans, and voice any questions or concerns about not being able to follow the treatment and discharge plans.
To respect hospital staff and other clients of IVVH. Any instances of verbal or physical abuse will not be tolerated and will result in the permanent discontinuation of services to protect the safety of our staff and clients.
Do you currently have a local Primary Care veterinarian that you are happy with (besides Irvine Valley Vet)?
By completing and signing this form, I agree to the terms and conditions listed above:

Repeater

Maximum file size: 52.43MB

Social Media Consent - I permit Irvine Valley Veterinary Hospital Inc. to record, own, publish, and republish photos and videos of my pet and reproductions of my pet's likeness for educational, marketing, and publicity purposes through any media. Unless otherwise requested, no personal information such as clients name, address, phone number, or email will be used. I acknowledge that the pictures or recordings taken on this date then become the sole and exclusive property of Irvine Valley Veterinary Hospital Inc.I release Irvine Valley Veterinary Hospital Inc. from any and all claims that might arise from the use of these images and recordings.
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