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Pet Name *

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Pet Insurance *

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Previous Veterinarian *

May We Request Records *

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I authorize veterinarians at the Glendale Veterinary Hospital to examine, prescribe for and treat any of my pets on file. I assume financial responsibility for all charges incurred in the care of my pets. I also understand that these charges will be discussed with me, will be paid at the time services are rendered and that a deposit *may* be required for emergency or surgical treatment.
Thank You for entrusting us with the care of your pets!

By CHECKING "YES", I agree to the above terms. *

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