rabbit care

LIBEVC Patient Registration Form

Please note: Appointments will be scheduled based on availability and urgency determined by our staff. If this is an emergency, please call our office before or immediately after registering your pet online. Once we receive an alert confirming your pet's registration, you will receive a call to schedule the appointment. Completion of this form does not guarantee availability. LIBEVC reserves the right to refuse service for any reason.

Client Information

Patient Information

Sex

Authorizations

CONSENT FOR TREATMENT - I, the undersigned owner or owner’s agent, of the pet(s) identified here, certify that I am over eighteen (18) years of age and thereby consent to the examination of my pet by the veterinarians and staff at Long Island Bird and Exotics Veterinary Clinic, and, after consultation with me, to prescribe medications for, treat, hospitalize, anesthetize, and/or perform surgery on my animal. I understand that some risks exist with medical treatment of animals and that I am encouraged to discuss my concerns in detail with LIBEVC staff prior to the initiation of treatment. Should it occur that unexpected life-saving emergency care is required and my attending veterinarian is unable to reach me, Long Island Bird and Exotics Veterinary Clinic has my permission to provide such treatment and I agree to pay for such care. I understand that LIBEVC does not provide 24-hours-per-day continuous supervision of my hospitalized animal.

Photo Permissions

I understand and agree to all the terms and conditions.

SIGNATURE - By signing below, I, the undersigned client or client’s agent, am confirming that all of the provided information on this form and on additional pet information pages is accurate and complete to the best of my understanding, and that I authorize the permissions as indicated above for treatment consent, financial responsibility, caretaker responsibility, release of information, and photo permissions.

Payments

Please note that this $87 deposit is non-refundable if an appointment is scheduled and you do not show or cancel the day of. It will be credited towards your first exam fee.
 Once your payment is processed through our website, one of our staff members will contact you within the business day (which may be the following morning if you complete this form overnight) to help you choose between our available appointment days and times. If we do not contact you within that time frame, please call us at 516-482-1101 or email us at office@birdexoticsvet.com; this will also help us to confirm that the online registration process worked correctly.
 The fee is to only cover the cost of the physical examination, any treatments discussed with the doctor will be additional costs due at the time of the exam. Thank you.

Thank you!