Cornell University Hospital for Animals


For Clients

Equine/Nemo Farm Animal Hospital Admissions Form

All fields with bold blue labels must be filled in.

By completing the information below you will be authorizing the release of information to your primary care veterinarian.
(Information cannot be released to your vet unless filled out below)

If animal is insured, please provide insurance agency.
  •  and authorize the Hospital to speak with only the person and/or persons listed on this registration form regarding medical and treatment decisions.
  •  is to provide patient care and to advance the practice of veterinary medicine through education, clinical investigation and scientific discovery. I understand that case records and specimens are the property of Cornell University. I consent to the use of acquired specimens, data, images and video recordings for treatment, research or teaching purposes, provided neither my animal nor I are identified in any publication, report or presentation without my prior written authorization.
  •  the examination, sample collection, and diagnostic procedures necessary to evaluate my animal, and I confirm my understanding that full payment is due at the time of discharge.
Owner must be 18 years of age or older

Please be sure that you have signed in your vehicle with the receptionist. If you have information from your regular veterinarian, please give that to the receptionist with this form.

Payment is required at the time of service.

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