New Patient Registration Form

Email(Required)

Home Phone

Cell Phone

Phone

*Owner and Co-Owner have sole and equal authority to, authorize prescriptions, approve estimates and authorize treatments including and up to euthanasia. Other family members or caregivers will need to fill out a ‘Caregiver Authorization Form’.

Who do we thank?

Pet Information

Pet's Name(Required)

Date of Birth or Approximate Age(Required)

Breed(Required)

Color(Required)

Second Pet's Information

Pet's Name

Date of Birth or Approximate Age

Breed

Color

Third Pet's Information

Pet's Name

Date of Birth or Approximate Age

Breed

Color

Hospital Policies

We strive to provide excellent customer service and high-quality patient care. The following are important topics and we like to be proactive and follow your wishes. Please do not hesitate to inquire if you would like further explanation or more information on any of these topics. You can change your preferences at any time.

In case of an emergency: I authorize MuraBella Animal Hospital to perform life-saving measures including CPR up to $500 in cost. I understand the doctor will only utilize this agreement if my pet's heart stops beating or my pet stops breathing while at MuraBella Animal Hospital.

Many drugs that have been approved for use in humans and/or some animals have also been proven to be safe and effective in species for which the drug is not labeled. Our Veterinarians, often by necessity, must recommend, administer and prescribe drugs that are considered off-label. With notification, I authorized my pets’ veterinarian to use off-label medications where appropriate.

I authorize the release of my pet’s medical records to local government, grooming, boarding, daycare, and veterinary facilities without additional consent. Additionally, in the event that you’ve notified us your pet is covered by veterinary pet insurance, we will send medical records to your insurer when requested.

At times you may invite an employee or another 3rd party service whom we recommend watching your pets / home when you are out of town. These services are established privately and are separate from any medical care or veterinary services you are receiving from MuraBella Animal Hospital.

Cancellations without 12hrs notice or No-Show Appointments will be charged a $20 fee. If you are more than 15 minutes late to your appointment you may have to wait or be rescheduled to another day.

If your pet is staying in the hospital with us, examples include surgery, drop-off appointment, grooming, hospitalization, and other reasons, and live fleas, ticks, or other parasites are found on your pet, they will be treated for this issue with no additional communication and at your sole expense. This ensures the health and safety of other patients and team members.

There are risks involved when purchasing pharmaceuticals or food products for your pet over the Internet or from pharmacies that do not get their products directly from the manufacturer. By signing, I acknowledge that I have been informed of the risks involved, and accept any and all responsibility, financial or otherwise, that may occur from this decision. I understand that MuraBella Animal Hospital, including staff, doctors, and affiliated parties will be held harmless from the use of products and/or prescriptions purchased from sources outside of the clinic’s monitoring and control.

Signature(Required)

Pet Information

Second Pet's Information

Third Pet's Information

Hospital Policies

Contact Us

Hours

Sister Location