New Client Registration – Rolesville Veterinary Hospital at Forestville Crossing Name First Last Address Street Address Address Line 2 City State Zip Code Email Primary PhoneHome PhoneWork PhoneHow did you hear about us? Sign Recommendation Other Who recommended you?Thank you for choosing Rolesville Veterinary Hospital! Our primary mission is to provide compassionate care, affordable rates, and superior comprehensive veterinary care with a family approach. We diligently strive to ensure that the cost of quality veterinary care is as economical and manageable for our clients as possible by offering multiple payment options.We offer multiple payment options in the form of: Cash, Check, Visa, MasterCard, Discover, American Express, and Care Credit.**All returned checks will be charged an additional $35.00.**Any necessary treatments and/or hospitalized care will be provided an estimate and a REQUIRED deposit amount of 50% of the estimated cost of care is due prior to procedures.**Rolesville Veterinary Hospital requires payment in FULL at the time of check out.**By signing below, you acknowledge and fully understand the Rolesville Veterinary Hospital financial policy and agree the Rolesville Veterinary Hospital terms of payment.Electronic Signature(Required)Photo ConsentI hereby grant Rolesville Veterinary Hospital permission to take photographs of my pet(s), and to publish those photographs for any lawful purpose, including but not limited to their website, social media accounts, and promotional materials either digital or in print, in perpetuity. I understand that Rolesville Veterinary Hospital will not use my name or my pet's name.By electronically signing this form I authorize Rolesville Veterinary Hospital to edit and share the photograph(s) mentioned above. I also waive any rights of privacy or compensation associated with the use of my pet(s) image(s) for the personal or commercial purposes outlined above.Electronic SignaturePet Registration1st PET INFORMATIONPet NameSpecies Dog Cat Reptile Exotic BreedColorDate of Birth MM slash DD slash YYYY If unknown, approximate age:Sex Male Female Spayed/Neutered? Yes No Is your pet up to date on vaccines? Yes No Please list prior illnesses, surgeries, or allergies:Is your pet currently on any medications? Yes No Names and dosage:2nd PET INFORMATIONPet NameSpecies Dog Cat Reptile Exotic BreedColorDate of Birth MM slash DD slash YYYY If unknown, approximate age:Sex Male Female Spayed/Neutered? Yes No Is your pet up to date on vaccines? Yes No Please list prior illnesses, surgeries, or allergies:Is your pet currently on any medications? Yes No Names and dosage:
