New Patient Form

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Holland Veterinary Hospitals in Hattiesburg to release patient information to the primary care hospital or veterinarian.

By submitting this form, I hereby authorize Holland Veterinary Hospitals in Hattiesburg to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Holland Veterinary Hospitals in Hattiesburg.

Please fill this section in if we are not your primary care veterinary hospital. By listing your primary care veterinarian, you are authorizing Holland Veterinary Hospitals in Wiggins to release patient information to the primary care hospital or veterinarian.

By submitting this form, I hereby authorize Holland Veterinary Hospitals in Wiggins to render medical care for my pet(s) as deemed necessary by the veterinarian. I understand that no guarantee can be given to the outcome of treatments and take it as my responsibility to comprehend any risks involved. I agree to pay for the cost of all services to which I consent to by written or verbal estimate. I understand that a deposit is required before diagnostics and treatments can be initiated and that payment in full is required prior to discharge of patient from Holland Veterinary Hospitals in Wiggins.