Rye Harrison Veterinary Hospital

New Client/Patient 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.

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New Client/Patient Information form
Contact Name *
First Name
Last Name
Co-Owner Name
First Name
Last Name
Contact Address *
Address 1
Address 2
City
State / Province
Zip / Postal Code
Contact Phone Number *
Co-Owner Phone Number
Contact Email Address *
In case of an EMERGENCY, please call: *
How did you hear about us?
Do we have your permission to use photos of your pet on our website/social media accounts? *
Does your pet have an Instagram handle we should tag them in?

Payment:

We accept cash, checks, all major credit cards, and CareCredit for your convenience. We are PCI compliant  to ensure your identity and privacy are secure. 

If you would like to leave your credit card on file as a convenience for future use, please initial here and inform the receptionist.
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I understand that I may receive a written fee estimate if I request one and that a final fee will be based on actual services rendered. Payment is due as services are rendered. For hospitalized cases, a deposit is required in advance. The balance is due upon discharge from the hospital. In the event payment is not made at the time of service, it is our policy to apply a service charge to accounts with a balance over 30 days old. All returned checks will incur a charge of $35.00. In the event the account is referred for collection, balances owed will be subject to additional annual interest charges of 16%. *
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Today's date *
Date

Join the Rye Harrison Veterinary Hospital Family Today!

Located off of Exit 19 on I-95 (New England Thruway) between Theodore Fremd Ave and Maple Ave.

Phone: 914-921-2000

  • Monday: 8:00 am - 8:00 pm
  • Tuesday: 8:00 am - 8:00 pm
  • Wednesday: 8:00 am - 5:30 pm
  • Thursday: 8:00 am - 8:00 pm
  • Friday: 8:00 am - 5:30 pm
  • Saturday: 8:00 am - 1:00 pm
  • Sunday: Closed

If you are experiencing an emergency after hours, please call us at 914-921-2000 and you will be directed to the after hours support.

Book an Appointment