Please fill out and submit online prior to your arrival at CUVS.
How do your prefer to be contacted?
Please list preferred contact method if "other" is selected:
If we are unable to reach you, who may we contact in case of emergency?
Do you authorize this person to make urgent treatment decisions if you are unreachable?
Please list people in addition to your primary care veterinarian to whom we may release information:
How did you hear about us?
Primary Veterinarian Name and Phone Number:
By listing your primary care veterinarian above, you are authorizing our hospital to release patient information to the additional hospital or veterinarian(s) listed. Are there any other veterinarians to whom you would like us to send updates or information?
(If yes please list here)
Presenting Problem / Special Needs / Concerns:
Send us a photo of your pet:
Please send jpg files only
I hereby authorize CUVS to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of my pet from CUVS.
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24 Hours a day, 7 days a week
Emergency & Critical Care Information
Monday - Friday
9am to 6pm
Weekend hours available by special appointment
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