• Please fill out everything

  • Emergency contact information

  • If you have a family veterinarian other than Evergreen Animal Hospital, I understand treatment records will be forwarded to the named veterinarian and by signing this authorization I hereby give permission for my pets records to be released.
  • Treatment Authorization & Information

  • I hereby authorize Evergreen Animal Hospital to perform medical and diagnostic/surgical procedures on my pet as required for diagnosis and treatment. I understand that I can terminate treatment at any time by contacting the doctors or technicians.
  • I do hereby grant EAH and its assigns representatives the right to use my pet's photo and images for advertising, facebook, website etc.
  • How did you find us?

  • PLEASE NOTE: Current Drivers License # is needed for payment by check or credit card. We cannot accept out of state or post dated checks.
  • Financial Policy

    We offer Care Credit, an outside lending service, if payment can't be made at time of service. Ask if needed

  • Payment Is Due In Full As Services Are Rendered.

  • I understand that I, as the owner or agent, am financially responsible for the applicable Evergreen Animal Hospital charges relating to the treatment my pet(s). I have read and agree to the treatment authorization. I have also read and accept the financial policy.
  • Pet Emergencies When The Owner Isn't Available For Direction

    I do hereby grant Evergreen Animal Hospital and its assigns, licensees, and legal representatives the irrevocable right to use my and my pet(s) photograph/image for advertising, or any lawful purpose, and I waive my right to inspect or approve the product.
  • Thank You For Allowing Evergreen Animal Hospital To Provide For Your Pets Health Care Needs