• Owner / Caregiver

    Please provide the information below as completely as possible. All information is strictly confidential.
  • Pet Information

  • Referral Information

  • Statement Of Ownership

    By checking below you certify that you are the owner and or agent of the above animal and have the authorization to consent to treatment if and when it is needed.
  • General Medical History

  • History of Current Problem

  • Authorization: I hereby authorize Peak Performance Veterinary Group to examine, prescribe for, and treat the above-mentioned pet. I assume all charges incurred in the care of the animal. ALL PROFESSIONAL FEES ARE DUE AT THE TIME SERVICES ARE RENDERED. I consent to release all medical information to and from my regular daytime veterinarian.

    Cancellation and No-Show Policy: We excel in quality care by scheduling the appropriate amount of treatment time for each patient. Your appointment is a specific time that we set aside especially for you and your companion, so it is extremely important to be timely. If you are unable to keep your appointment, YOU MUST NOTIFY THE OFFICE 48 HOURS IN ADVANCE. You will be charged a normal appointment fee for no-shows, and you may be charged a missed appointment fee for tardiness of 10 minutes or more. You will be asked to reschedule your appointment if you are 10 minutes late. Thank you for your consideration and assistance.

  • This field is for validation purposes and should be left unchanged.