Cornell University Hospital for Animals


For Clients

Client/Patient Registration

All fields with bold blue labels must be filled in.

Client Information

Owner's Name

Co-Owner's Name

Patient Information
(If multicolored, list predominant color first)
Veterinarian Information
  •  and authorize the Hospital to speak with only the person and/or persons listed on this registration form regarding medical and treatment decisions.
  •  is to provide patient care and to advance the practice of veterinary medicine through education, clinical investigation and scientific discovery. I understand that case records and specimens are the property of Cornell University. I consent to the use of acquired specimens, data, images and video recordings for treatment, research or teaching purposes, provided neither my animal nor I are identified in any publication, report or presentation without my prior written authorization.
  •  the examination, sample collection, and diagnostic procedures necessary to evaluate my animal, and I confirm my understanding that full payment is due at the time of discharge.
Owner must be 18 years of age or older

Please be sure that you have signed in your vehicle with the receptionist. If you have information from your regular veterinarian, please give that to the receptionist with this form.

New York State Law requires a valid rabies certificate to be presented upon arrival to our hospital. Failure to do so may result in your pet not being evaluated.

Payment is required at the time of service.

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