New Client Form

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.

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.

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. Therefore, I hereby freely and voluntarily consent to the use and publication of my name, participation, picture, or likeness by the Practice or its employees or agents for any and all purposes including but not limited to, educational, promotional, advertising, and trade, through any medium or format including but not limited to videotape, audiotape, film, photograph, television, radio, digital, internet, theater, or exhibition, at any time from this date forward. I further waive any claims against the Practice, its employees, or agents based upon or related to its use or publication of my likeness, voice, participation, or picture. I freely give this authorization without expectation of compensation.