Client/Patient Registration Form

  • Welcome! Thank you for choosing the University of Georgia Veterinary Teaching Hospital for the care of your animal. We are passionate about what we do and are committed to treating you and your animal/pet with the utmost compassion and respect while providing the best medical care possible. So that we may best accommodate you and your animal, please complete the following:

  • Primary Owner (Client) Information

  • Co-Owner (Client) Information (if applicable)

  • Patient (Animal) Information

  • Primary Veterinarian Information

  • Additional Veterinarians/Clinics Involved

  • (use the plus icon to add additional rows as needed)
    Clinic/Practice NameCity/StateClinic Phone NumberPrimary Veterinarian Seen/Preferred 
  • Financial Agreement & Authorization

  • I hereby authorize the University of Georgia Veterinary Teaching Hospital to perform medical and initial diagnostic/surgical procedures on this animal as required for diagnosis and treatment. I understand that a written or verbal estimate will be provided after the initial evaluation, and that I am responsible for the payment of all services rendered, and that I can terminate treatment at any time by contacting the veterinarian on the case. I understand that in the event that the animal is hospitalized or admitted into the hospital, a deposit of 50% of the high-end of the estimate is required in advance. The balance is due upon discharge from the hospital. Payments can be made by cash, personal check, all major credit cards and Care Credit®. The UGA Veterinary Teaching Hospital does not offer payment plans, price matching, or discounts.

    Information obtained during the evaluation and treatment of animals to the Veterinary Teaching Hospital is the property of the University of Georgia College of Veterinary Medicine and becomes a part of the Veterinary Teaching Hospital (VTH) medical record. This includes written accounts of case histories and management, products of diagnostic procedures, tissues, photographs/video, and diagnostic images of the patient. I consent to the use of the accumulated information for the purposes of laypersons meetings. Neither the name of the client nor patient will be used to identify medical information relating to the patient. I give the Veterinary Teaching Hospital permission to communicate medical information on the patient to my regular veterinarian.