New Client Form

**By signing this waiver I give Higley Groves Animal Hospital the right to use my pets’ photo provided for reproduction in any medium, including but no limited to; website, video, broadcast, print and any electronic means for purposes of advertising, trade, display, exhibition or editorial use. Further, you also (i) agree to release Higley Groves Animal Hospital from all claims for libel, slander invasion of privacy, infringement of copyright or right of publicity or any other claim and, (ii) confirm that you are over the age of 18 years old.

System and office managers will establish administrative, technical, and physical safeguards to ensure the security and confidentiality of records, protect the records against possible threats or hazards, and permit access only to authorized persons. Automated systems will incorporate security controls such as password protection, verification of identity of authorized users, detection of break-in attempts, firewalls, or encryption, as appropriate.
I understand that I assume responsibility for all charges incurred in the care of my animal(s) and that all fees are due at the time services are rendered.

I hereby authorize the veterinarian at Higley Groves Animal Hospital to examine, prescribe for or treat the above described pet. I assume responsibility for all charges incurred in the care of my animal. I understand that all fees are due at the time services are rendered.