Medical Care Disclosure Form

Save time during your next appointment! Complete your medical care disclosure form online from any device before your visit.

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Medical Care Disclosure Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

OR

You may use the PDF version by clicking the DOWNLOAD FORM button and completing the printed form by hand. Please bring the completed PDF form with you for your pet’s first appointment.

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Owner's Name *

First

Last

Pet's Name *

Email *

Hartwood Animal Hospital has medical staffing and business hours as follows:
Mon-Fri: 7:30 AM – 7:00 PM
Sat: 7:30 AM – 1:00 PM
Sun: Closed

The hospital is closed on the following holidays:

New Year’s Day, Memorial Day
Fourth of July, Labor Day
Thanksgiving, Christmas Day

This is to inform you that we do not have continuous medical staffing outside of the
above listed hours.

In accordance with State of Virginia Law, Act 54.1-3806.1, effective July 1, 1998,
Veterinary practices admitting patients to their facilities must disclose hours of
continuous medical care and retain written documentation of the owner's signature

Disclosure Agreement *

I have read and understand the above disclosure form.

Signature *

Clear Signature

Date *

Message

Medical Care Disclosure Form

Medical Care Disclosure Form

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Contact Information

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