Client Registration & Consent Step 1 of 3 33% Please ensure that you have called us at (952) 953-3737, and that you will be bringing your pet to us, so that we can expect the required forms prior to your arrival.Client InformationOwner's Name* Email Address* Immediate/Mobile Phone* Alt. Mobile/Home Phone* Home Address* Street Address City State ZIP / Postal Code Car Color, Make, & Model* Pet Health HistoryPet Name* Species* Cat Dog Other SexMaleNeutered MaleFemaleSpayed FemaleUnknownAge* Breed* Color/Markings* Who is your regular veterinarian?* Letting us know who you will be taking your pet back to will help ensure that your pet's medical records arrive there in a timely fashionReason(s) for Visit* Are Vaccinations Current?* Previous Medical Problems Current Medications Chemotherapeutic Drugs Known Allergies How did you hear about us? Client ConsentPAYMENT REQUIRED AT TIME OF SERVICE ALL ANIMALS MUST BE PICKED UP BY 7:30 A.M. WEEKDAYS DEPOSIT REQUIRED ON ALL HOSPITALIZED ANIMALSAuthorization*Please SelectYes, I authorize.No, I do not authorize.I hereby authorize South Metro Animal Emergency Care and its staff to evaluate and treat my pet. I will be responsible for the standard Emergency Exam Fee of $144.00 and any diagnostics or initial treatments verbally agreed to prior to a written estimate. No guarantee of successful treatment is made. I will not hold the emergency facility responsible for my pet’s recovery and agree to pay all charges incurred at the time of release of my pet. In the event my pet is hospitalized, I will need to leave a deposit at the front desk and return the next regular business day by 7:30 a.m. to transfer my pet to my regular veterinarian for further care. I further understand that my pet must be picked up when instructed or alternative transport by a family member or other authorized party must be made known to staff by the primary owner, and additional consent may be required for such transport to be enabled. Appropriate hospital and late fees will be incurred until the pet is released. Consent to Distribute Medical Records I authorize: South Metro Animal Emergency Care to release copies of my pet's medical records and supporting documents such as radiographs and diagnostic results to the primary physician of my choice. I understand that this information shall be in effect for 1 year following the date of signature. However, I understand that this authorization may be revoked at any time by giving oral or written notice to SMAEC. I understand that once my pet's medical records have been released, the medical office cannot retrieve them and has no control over the use of the already released copies.Media Authorization*Please SelectYes, I authorize.No, I do not authorize.I understand that South Metro Animal Emergency Care may take pictures and/or videos of my pet for continuing education, medical publications, or promotional purposes. These images will have no identifying information about me or my family associated with them. They may contain my pet's name. I will claim no ownership of or authority over said media documents.Signature*CommentsThis field is for validation purposes and should be left unchanged.