New Client Consent Form

CLIENT INFORMATION

PET INFORMATION

Tell us about your pet(s) *

 
Name
 
Feline/Canine Breed Colour DOB/Age Sex
 Pet #1 
 Pet #2 
 Pet #3 
 Pet #4
 Pet #5

PERSONAL INFORMATION CONSENT

At Cranston Veterinary Hospital we respect your right to privacy and will not collect, use or disclose any personal information regarding you and your pet without your consent. The information we seek from you is obtained so that we can provide a high quality of veterinary service and ensure that you are fully aware of our actions. We may use the information provided to contact you, including electronic communications, to assist in the health care of your pet and to reunite you with your pet in the event that they become lost.

 

In all cases, we will only disclose personal information about you and your pet in circumstances where we believe that it will be beneficial to the continued care and good health of your pet, such as a referral to a specialist or emergency veterinary facility.

 

Please indicate below that you will permit us to disclose personal information in those situations.

 

Today
How did you hear about us?




How would you like to be contacted in regards to your pets' health care? *


Should you have any questions regarding our collection, use or disclosure of your personal information, please contact Dr. Martin Baer.

 

 

Please verify that you are human *