Now Offering Same-Day Urgent Care Appointments!
For very sick or urgent pets—call after 8:00 a.m. to book. Limited spots available, so call early!
Exam fee: $65 per pet
Kingsport Veterinary Hospital

Client Information Update Form

Please fill out our Client Information Update Form as completely and accurately as possible!

Kingsport Veterinary Hospital

Client Information Update Form.

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit. If this is an emergency, or if your pet needs urgent care, please Appointment at 425-246-8561 for a faster response.

Also, please review our cancellation policy.

Name(Required)
Address
Who else is authorized to make decisions about your pet's healthcare?
** PAYMENT IS EXPECTED AT THE TIME SERVICES ARE RENDERED **(Required)
We accept cash, checks, Visa, and Mastercard, Discover, Care Credit. I, the undersigned owner or authorized agent of the above admitted patient, hereby authorize the doctors of Kingsport Veterinary Hospital to administer such treatment as is necessary and to perform procedures therapeutically and/or diagnostically. I further understand that no guarantee of successful treatment is made. I also assume financial responsibility for all charges incurred and agree to pay all such charges at the time of release. I understand that unpaid balances are subject to a monthly finance charge and or collection fees and penalties.
** CANCELLATION POLICY **(Required)
To allow sufficient time for all patients and our scheduled procedures, we operate primarily by appointment. We accept walk in appointments in order to see our clients who have a difficult time coming in during the week. Emergencies are always our top priorities, so unfortunately an occasional delay is inevitable, though we do our best to see each client in a timely manner. You can read and view the cancellation policy here.
Photo Release(Required)
I certify that I am over the age of 18, I understand that Kingsport Veterinary Hospital may take or receive photographs, video, audiotape and other image and sound-based media of its office, including its employees, patients, and other visitors. The Practice may wish to use such photographs for educational, promotional advertising, and other purposes. This permission for release, without compensation or prior notice would allow the Practice to use photographs in its printed publications, during presentations, and otherwise
Clear Signature
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.