Ethos Veterinary Health
  • Veterinary Teams
    • Submit a Referral
    • Hospital Updates
    • Ethos Materials for Clinics
    • Continuing Education
    • Veterinary Compounding
    • VetBloom CE
    • Ethos Discovery
    • Clinical Studies
    • Emergency/Critical Care + Specialty Hospitals
    • Veterinary Urgent Care Clinics
  • Our Hospitals
    • NORTHEAST
      • Boston West
      • Bulger
      • Capital District
      • Mass Vet
      • Peak
      • Port City
      • SAVES
    • MIDWEST
      • Premier – Chicago
      • Premier – Grayslake
      • Premier – Orland Park
      • WVRC – Grafton
      • WVRC – Racine/Kenosha
      • WVRC – Waukesha
    • PACIFIC
      • Atlantic Street
      • VERC
      • Vista
      • VSH – North County
      • VSH – Sorrento Valley
    • URGENT CARE – East Coast
      • Station Landing, Medford MA
      • NOW OPEN – Nashua, NH
    • URGENT CARE – West Coast
      • Irvine, CA
      • Oceanside, CA
      • Rancho Peñasquitos, San Diego, CA
  • Our Services
    • Continuing Education
    • Blood Donor Program
    • Clinical Studies
      • FAQs: Clinical Studies at Ethos
    • Ethos Discovery
    • Ethos Science Consultancy
    • VetBloom CE
    • Hospital Services
  • About Us
    • About Us
    • Why Ethos
    • Veterinary Urgent Care by Ethos
    • Ethos Discovery
    • Leadership Team
    • Press Releases
    • Contact Us
  • Blogs & Videos
    • Our Blogs
    • PAWEDCast
    • Diagnosing Inequality Podcast
  • We’re Hiring!
    • Apply Today
    • Ethos Job Fairs
    • Employee Benefits
    • Giving Back
    • Veterinary Training Programs
Ethos Veterinary Health
  • Our Hospitals
    • NORTHEAST
      • Boston West
      • Bulger
      • Capital District
      • Mass Vet
      • Peak
      • Port City
      • SAVES
    • MIDWEST
      • Premier – Chicago
      • Premier – Grayslake
      • Premier – Orland Park
      • WVRC – Grafton
      • WVRC – Racine/Kenosha
      • WVRC – Waukesha
    • PACIFIC
      • Atlantic Street
      • VERC
      • Vista
      • VSH – North County
      • VSH – Sorrento Valley
    • URGENT CARE – East Coast
      • Station Landing, Medford MA
      • NOW OPEN – Nashua, NH
    • URGENT CARE – West Coast
      • Irvine, CA
      • Oceanside, CA
      • Rancho Peñasquitos, San Diego, CA
  • Our Services
    • Continuing Education
    • Blood Donor Program
    • Clinical Studies
      • FAQs: Clinical Studies at Ethos
    • Ethos Discovery
    • Ethos Science Consultancy
    • VetBloom CE
    • Hospital Services
  • About Us
    • About Us
    • Why Ethos
    • Veterinary Urgent Care by Ethos
    • Ethos Discovery
    • Leadership Team
    • Press Releases
    • Contact Us
  • Blogs & Videos
    • Our Blogs
    • PAWEDCast
    • Diagnosing Inequality Podcast
  • We’re Hiring!
    • Apply Today
    • Ethos Job Fairs
    • Employee Benefits
    • Giving Back
    • Veterinary Training Programs
  • Veterinary Teams
    • Submit a Referral
    • Hospital Updates
    • Ethos Materials for Clinics
    • Continuing Education
    • Veterinary Compounding
    • VetBloom CE
    • Ethos Discovery
    • Clinical Studies
    • Emergency/Critical Care + Specialty Hospitals
    • Veterinary Urgent Care Clinics

Client Registration

Step 1 of 5

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  • Ethos Veterinary Health Hospitals

  • Please select the hospital where you are planning to receive treatment from the dropdown list above. The hospital team do not have access to other hospitals' registration forms. Selecting the wrong hospital, or no hospital, will require you to fill the form out a second time. Thank you for your kindness and understanding.
  • Owner Information

  • State Guidelines require that the caregiver’s date of birth be recorded when distributing controlled medications.
  • We will use your email to send appointment reminders, medical communications and a client survey.
    • Co-Owner/Alternate Contact

    • State Guidelines require that the caregiver’s date of birth be recorded when distributing controlled medications.
    • We will use your email to send appointment reminders, medical communications and a client survey.
    • Patient Information

      We take pictures of your pet for identification and as part of the medical record. These photos are not shared outside of the medical record.
    • Please enter the number of years (7 years), or enter the date of birth in the format: mm/dd/yyyy.
    • MM slash DD slash YYYY
    • Vaccine NameDate (mm/dd/yyyy) 
    • Referring Veterinarian Information

      Our medical team will communicate with the referring veterinarian indicated on the form to ensure continuity of care.
    • Name of the veterinarian who provides your pet's routine veterinary care.
    • Where do take your pet for routine care? If you do not know, or don't have one, please say "none".
    • Confirmation and Consent

      Please read the important information below and respond on behalf of the primary pet-owner.
      With your permission, if circumstances are appropriate, we may take photos of your pet for marketing or educational purposes. We do not share personal information including your last name, confidential medical information and communications with your veterinarian. We may identify you and your pet by first name. I grant permission and acknowledge and agree that no sums whatsoever will be due to me as a result of their use.
    • I consent to an examination of my pet by the providers at this Ethos Veterinary Health hospital. I understand that diagnostics and treatment along with the associated costs will be discussed with me prior to delivery and I have the right to decline. If my pet is hospitalized, I understand the provider will present an estimated treatment plan with the associated costs, however, treatment may vary throughout the duration of my pet’s stay. I will be informed of any costs that exceed the initial treatment plan so I am able to make informed decisions about my pet’s care.

      I understand that Ethos requires 24-hour notice to reschedule or cancel appointments. Appointments that are not canceled prior to 24 hours may incur a charge equal to the consultation fee.

      Payment is due at the time of service and any remaining balance must be paid when services are complete. All day services and hospitalizations require a deposit in full of the estimated cost.

      I understand that photos for marketing or educational purposes may be taken of my pet, if circumstances are appropriate. Personal information is not shared including last name, confidential medical information and communications. My pet and I may be identified by first name. I grant permission and acknowledge and agree that no sums whatsoever will be due to me as a result of the use.

      I understand that a photograph of my pet for identification purposes is captured and stored in the medical record. This is used identification and is not shared. This photo is compulsory as it ensures proper care for your pet while in our care.

      I am the legal owner or representative of the legal owner of the animal being presented and I am 18 years or older.
    • Please write your name to represent your signature

    Ethos Veterinary Health
    • Veterinary Teams
      • Submit a Referral
      • Hospital Updates
      • Ethos Materials for Clinics
      • Continuing Education
      • Veterinary Compounding
      • VetBloom CE
      • Ethos Discovery
      • Clinical Studies
      • Emergency/Critical Care + Specialty Hospitals
      • Veterinary Urgent Care Clinics
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