New Patient Form for Dogs & Cats

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Van Roekel & Associates to release patient information to the primary care hospital or veterinarian.

By submitting this form, I hereby authorize Van Roekel & Associates to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Van Roekel & Associates.