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24 Hour Emergency
- Urgent Care

152 Sparrowbush Road, Latham, New York 12110

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Location & Hours
Contact Us

518.783.3198

518.783.3199

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About Us
- Our Doctors
- Our Staff
Specialties
Pet Owners
Referring Veterinarians
Forms
Medication Refills
Careers
24-Hour Emergency
- Urgent Care

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Client Information Form

Client Information Form

Please complete our Client Information Form before your scheduled appointment. Thank you!

"*" indicates required fields

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

Have you ever been to Upstate Veterinary Specialties?*

Yes

No

If yes, please tell us the name of the pet

Do you currently have an appointment scheduled with a UVS veterinarian?*

Yes

No

Please contact Upstate Veterinary Specialties at 518-783-3198 to schedule your appointment before completing a new client form.

Please tell us which team your pet is scheduled to see:*

Please tell us the date of your appointment:

Month

Day

Year

Client Information

Client Name*

First Last

Client Cell Phone*

Do you consent to receive text messages from UVS?

Yes

No

Client Secondary Phone

Co-owner

First Last

Relationship

Co-owner Cell Phone

Client Address*

Street Address City State ZIP Code

Email*

Primary Veterinarian Information

A complete set of medical records is required prior to your appointment with a specialist. Please work with your primary veterinarian to make sure these records are received by UVS at least 48 hours before your appointment. Appointments without medical records may need to be rescheduled.

Primary Veterinarian Office*

Primary Veterinarian*

Pet Information

Pet's Name*

Species (Please check one)*

Canine

Feline

Sex*

Male Neutered

Male Unaltered

Female Spayed

Female Unaltered

Breed*

Color*

Age*

May we use photo(s) of this patient for Public Relations use?*

Yes

No

Authorization for medical and/or surgical treatment and financial responsibility*

I hereby authorize the doctor and designated technicians on duty to administer treatments considered therapeutically necessary. I understand that the estimated fee is based on treatment deemed necessary at the time of admission. In many cases, it is impossible to determine the full cost of diagnostics and treatment in advance. I understand that all fees must be paid in full at the time of service. I understand that the hospital requires 24 hours notice for a cancelled appointment, otherwise, I will be responsible for the cost of the appointment time.

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Refer your patient to one of our Specialists. We provide optimal care to sick and injured animals.

Our Specialists

Get to know our doctors’ training, certifications, and areas of specialization.

Meet Our Specialists

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Hours of Operation

Specialty Services: Monday – Friday 8am-6pm
*Subject to change during Holidays

Emergency Service: 24 hours a day / 7 days a week

Upstate Veterinary Specialties, PLLC

152 Sparrowbush Road, Latham, New York 12110
Phone: 518.783.3198 Fax: 518.783.3199

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