New Client Information

Your full-service pet hospital in Anchorage

Chester Valley Veterinary Hospital asks you fill out some forms when you visit us for care. If you would like to get started early and fill these forms out ahead of time, we'll be able to take you a little earlier for your appointment. No time to do this now? That's fine too. Just come a little bit early for your appointment so you are able to complete the needed paperwork prior to seeing the veterinary team. If you have questions about anything here, please feel free to call us for some help.
Click Here to Download New Client Paperwork Click Here to Download Medical History Form Click Here to Download Medical Release Form


Client Information Sheet

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Photo/Video Release
I hereby grant permission to the rights of my pet’s image, likeness and sound of his/her voice as recorded on audio or video without payment or any other consideration to Chester Valley Veterinary Hospital. I understand that my pet’s image may be edited, copied, exhibited, published or distributed and waive any right to royalties or other compensation arising or related to the use of my pet’s image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area.

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Treatment Authorization/Payment Authorization
I hereby authorize Chester Valley Veterinary Hospital’s doctor(s) and staff to examine my pet(s) and to discuss findings with me or an authorized representative. I understand that I am entitled to an estimate of charges for the care and treatment of my pet(s). I am also aware that regardless of my decision to proceed with the estimated treatment or not I am responsible for an exam fee.
I hereby consent to the care and treatment of my pet(s) by the staff at Chester Valley Veterinary Hospital. I give my permission to the administration of anesthesia and surgical procedures as seen fit by the physical in the event of an emergency as well as in the treatment of my pet(s).
I understand that an itemized receipt will be presented to me upon the release of my pet(s). I take full financial responsibility of all incurred charges for my pet(s). I also understand that full payment is expected before said pet(s) is released to me.
I fully understand that any pet(s) brought to Chester Valley Veterinary Hospital by the above person/persons or authorized representative will be considered abandoned, if the animal(s) is not collected within 10days of written notice to the above address. Upon which time Chester Valley Veterinary Hospital has the rights to adopt it out, sell, or euthanize without prejudice to its claims for fees or services rendered.

No Show/Cancellation Policy
I hereby understand that Chester Valley Veterinary Hospital requires a 24 hour notice to reschedule or cancel an appointment. Failure to call and cancel an appointment or arriving 15 minutes late to an appointment will be deemed a “no show”. A cancelled or no show appointment will incur a fee at Chester Valley Veterinary Hospital’s discretion and can result in the refusal of service at this practice.

I have read and fully understand the above authorizations, policies, payment requirements and risks.

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