Client Name(Required)
Address(Required)

Payment and Appointment Policies


View Payment Policy


I have read and understand Bloomsburg Veterinary Hospital’s Payment and Failed Appointment policies as posted in the reception area and the bloomvet.com website. I further understand that copies of these policies are available upon request.

MM slash DD slash YYYY

We frequently contact our clients using the telephone, email, and text messages. Do you prefer NOT to be contacted using any of these methods? If yes, please note below:

Connect with us on Social Media


Facebook: Bloomsburg Veterinary Hospital Inc. Instagram: bloomvet_ YouTube: @bloomvet

Permission to Use Photograph


I grant to Bloomsburg Veterinary Hospital, Inc., its representatives and employees the right to take photographs of me, my undersigned minor children, my pet(s) and my property in connection with the above-identified subject. I authorize Bloomsburg Veterinary Hospital, Inc., its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that Bloomsburg Veterinary Hospital, Inc. may use such photographs of me with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and web content.

I release Bloomsburg Veterinary Hospital, Inc. from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below and that I have the authority to authorize Bloomsburg Veterinary Hospital, Inc. to use their photographs and names.

I have read and understand the above:

Name
MM slash DD slash YYYY
This field is for validation purposes and should be left unchanged.