Client Information Form

  • Driver's license number only needed if paying by check.
  • Pet

  • I acknowledge that I am responsible for payment in full at the time of my pet’s discharge. I am also aware that VVS is pleased to provide specialized and critical care for my pet and any follow-up care related to today’s visit; this hospital does NOT provide routine preventive veterinary care.

    Peanut Law

    I understand that Virginia Veterinary Specialists has business and medical staffing hours Monday through Friday 8:00 am to 6:00 pm. The in house medical care after these hours is provided by the emergency service here (Greenbrier Animal Emergency Hospital), in association with Virginia Veterinary Specialists.

    CONSENT TO USE ELECTRONIC SIGNATURES

    BY CHECKING THIS BOX, CUSTOMER EVIDENCES ITS CONSENT TO THE USE OF ELECTRONIC SIGNATURES ON THIS AGREEMENT BY CUSTOMER AND/OR COMPANY AND TO THE ELECTRONIC DELIVERY OF SUCH AGREEMENT AMONG THE PARTIES.

  • Please print full name.
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