Client Patient Information Form

Pet Information

Scheduled appointments must be cancelled or rescheduled by phone at least 24 hours prior to the appointment. Any client that fails to arrive for a scheduled appointment without cancelling will be considered a no-show. After an established client has three no-show appointments, that client may be asked to place a deposit for their visit.

As owner, or duly authorized agent of the owner, the undersigned hereby consent and authorize the staff
of Anza Animal Clinic to care for, treat, and/or anesthetize as they deem advisable in the performance of
surgical or therapeutic procedures they determine to be indicated on the above patients or any patients of record.
The undersigned accepts financial responsibility for all services rendered and agrees to pay all charges for
services at the time and prior to release of the animal from the hospital. A written estimate for all expected
services will be provided in advance of treatment if requested. The estimate does not cover costs for services or
therapeutics that are not expected but determined to be indicated or necessary at time of service.

Any animal not picked up within 10 days following notification of release shall be deemed abandoned
by the owner and will be disposed of according to sections 1834.5 and 1834.6 of the California Civil Code. It is
understood that abandonment does not release the undersigned from paying all costs of the veterinary service.
Anza Animal Clinic does not provide overnight or after-hours care. There are no staff on the premises
after closing.

I hereby authorize Anza Animal Clinic to use my pet’s photo and/or information related to their
experiences at Anza Animal Clinic on social media for News Media, Promotional Materials, Written Articles,
and/or Photographs without expecting payments.