New Client Form

New Client Form
Thank you for trusting in us and allowing us to provide emergency medical care for your pet today. We understand that this may be a difficult time for you and your pet, and that your visit today and its associated fees are unexpected. Our goal is to provide your pet with high quality compassionate medical care and to communicate thoroughly with you regarding our recommended medical plan and the associated costs.
Please note, the cost of the emergency consultation today is $200 and is due at the time of service. This does not include any recommended treatments or diagnostics. Checking the box below indicates that you are aware of the $200 consultation fee and understand that payment is due at the time of service.
Are you over 18 years of age?

Pet Information

Your Pet's Veterinarian

As an emergency referral center it is our responsibility to care for your pet while your veterinarian is unavailable. Therefore, it is important for us to share our medical records with them. Please provide us with your veterinarians contact information so that we can send your pet's records to them in a timely fashion.
Please select one option
Your check here authorizes us to send your pet's medical records to the above named veterinarian



By signing this form and providing your number you consent to receive email and/or SMS text messages from us. Message rates vary. Not all carriers are covered. Standard messaging and data rates apply. You may update your preference, and cancel your consent, by notifying us at any time or by replying CANCEL/STOP to any message you receive from us.


We enjoy sharing photos and videos of our patients and their families on social media and occasionally on print materials, advertising, and educational material for the hospital. However, we will never do so without your consent.

You understand that Veterinary Medical Center of CNY may take and use photographs and/or videos of you and/or your pet with or without your name and for any lawful purpose, including education, publicity, illustration, advertising, and web content.
If you prefer NOT to have you or your pet photographed or recorded on video, please select one or both of the options below:
The Veterinary Medical Center does not receive funding from any state, county, or local programs. We are unable to provide billing services and must have a deposit prior to rendering services. Full payment is required upon receipt of service. We do not provide billing services, and we do not hold checks. We require a 75% deposit of the higher end of the estimate at the time of admission for hospitalization or outpatient treatment. We accept cash, checks, and credit cards. We offer various independent third party payment plan options. You must apply for and be approved for those options. Please ask one of our staff about applying for the payment options that are available if you are interested. The doctors and staff are not authorized to make changes to the hospital’s payment policy.