Pet Pre-registration - CVETS - Columbia Veterinary Emergency Trauma and Specialty

PRE-REGISTRATION

Get Set Up For Care.

We offer pet pre-registration for additional timeliness and peace of mind in the event of an emergency or other illness that needs specialty care should occur.

THINK AHEAD

When your pet needs emergency care it can be a stressful experience. Pre-registration allows you to provide us with the important details about your animal and their medical history before you need emergency or specialty care. Pre-registration is just another way we can help make things easier for you.

To pre-register your pet please fill out the form below and click submit. If we have any additional questions we will give you a call. Thank you for trusting CVETS.

Owner Name*
First Last
Co-Owner Name (If applicable)
First Last
Primary Phone*
SMS Text Agreement
I agree to receive text updates and reminders.
By checking this box, I agree to receive SMS/text messages from CVETS to the mobile number provided above. I understand I am not required to provide consent for texting as a condition of treatment. Reply STOP to cancel. Message and data rates may apply.
Additional Phone Numbers
Email*
Preferred Method of Contact*
- Call
- Text
- Email
Address*
No PO boxes per DEA guidelines.
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Are you active or retired military, law enforcement, or veterinary professional?*
- Yes, Military
- Yes, Law Enforcement
- Yes, Veterinary Professional
- No
Is there anyone in your household that is currently positive for COVID-19?*
- Yes
- No
Has anyone in your household had any respiratory disease or fever within the past two weeks?*
- Yes
- No
Have any of your pets been seen at CVETS before?*
- Yes
- No
How did you hear about CVETS?*
- Referral
- Social Media (Facebook, Instagram, Twitter)
- Television/Print Advertisements
- Other
Payment Policy & Treatment Consent*
I agree to the privacy policy and treatment consent.
I understand and agree to authorize the veterinarian to examine, prescribe for and provide initial diagnostics for my pet. I am aware a deposit may be required prior to work up. All accounts must be paid at time of discharge. I am 18 years old or older and am accepting financial responsibility for this patient’s medical care and assume responsibility for all fees associated with the collection of any unpaid balance.
Photo, Video, and/or Recording Consent*
CVETS or its officers, employees, or agents may take photos of patients for education, advertising, media, video, audio or other marketing purposes.
- I DO authorize photos, video, or recordings of my pet.
- I do NOT authorize photos, video, or recordings of my pet.
Pet Name*
Date of Birth or Approximate Age*
Spay/Neuter/Intact*
Species*
Breed*
Color*
Primary Veterinarian Practice Name*
Primary Veterinarian Name*
Reason For Visit*
Please list all medications that your pet is currently on, including herbs and/or supplements below, as well as their last dosage.*
Which department are you coming to see?*
You should only select a Specialty service if you already have an appointment.
Name
This field is for validation purposes and should be left unchanged.