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24/7 Emergency
(802) 863-2387

Client Registration Form

    CLIENT INFORMATION

    Primary Veterinarian:

    Primary Animal Hospital:

    Pet Owner:

    Co-Owner:

    Mailing Address:
    P.O. Box / Street

    City/Town

    State

    Zip

    Pet Owner Primary Phone:

    Primary Owner E-mail:

    Co-Owner Primary Phone:

    Co-Owner E-mail:

    Are you 18 years of age or older?
    YesNo

    How did you hear about us?
    VeterinarianFriendWebEventOther:

    PET INFORMATION

    Reason for Visit:

    Name

    DogCatOther:

    Breed:

    Color:

    Gender:
    MaleFemaleUnknown

    Spayed / Neutered:
    YesNoUnknown

    Date of Birth / Age:

    Current Medications:

    I assume responsibility for the above described pet and hereby authorize the veterinarian to examine, prescribe for, and provide
    treatment as deemed necessary for the health, safety, or well-being. I assume responsibility for all charges incurred in the care of this
    animal regardless of outcome. I also understand that these charges will be paid at the time of release and that a deposit may be
    required prior to treatment. I will be responsible for any fees incurred by BEVS in the process of collecting my balance.

    A 50% DEPOSIT MAY BE REQUIRED PRIOR TO TREATMENT WITH BALANCE DUE AT DISCHARGE

    TRAFFIC/CONSTRUCTION ALERT: We've learned that Kimball/Marshall Avenue will be closed to through traffic beginning Monday, August 2, and continuing until at least November. If you're coming to BEVS from the north or west and would normally use Kimball/Marshall, please seek an alternate route to avoid the road closure. Feel free to call us for directions at (802) 863-2387. Please click here for more.
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