Client and Patient Profile

    Fill in these fields only if you have an additional horse

    We love to share photos of our patients! Do you give us permission to share photos of your horse on social media?

    I hereby authorize the veterinarians to examine, prescribe for or treat horses that belong to me or are under my direct care.

    I assume responsibility for all charges incurred in the care of these animals, including consultation fees for telephone, verbal and written communications and fees for any documentation including outside prescriptions. All unpaid balances will accrue a finance charge of 1.5% per month and a $10.00 billing charge. In the event that fees are not paid as delineated above, I agree to pay any and all
    collection and/or attorney’s fees incurred:

    Previous veterinarian from whom records may be requested:

    I do do not authorize Advanced Equine to use my/my horses' images for social media/website/promotional use.

    I hereby authorize the veterinarians to examine, prescribe for or treat horses that belong to me or are under my direct care.

    I assume responsibility for all charges incurred in the care of these animals, including consultation fees for telephone, verbal and written communications and fees for any documentation including outside prescriptions. All unpaid balances will accrue a finance charge of 1.5% per month and a $10.00 billing charge. In the event that fees are not paid as delineated above, I agree to pay any and all collection and/or attorney’s fees incurred:

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