Skip to content
    FOR VETERINARIANSPATIENT FORMSAPPOINTMENT REQUESTPHARMACYFEES + PAYMENTCONTACT
207-878-3121
    Facebook
207-878-3121
    ABOUT
    EMERGENCY CARE
    OverviewTriage
    SPECIALTY CARE
    OverviewCardiologyDermatologyInternal MedicineNeurologyOncologyOphthalmologyRadioactive Iodine Therapy for Hyperthyroid CatsDiagnostic ImagingRehabilitation & Regenerative MedicineSurgerySynovetin OA
    WHAT TO EXPECT
    TEAM
    All DoctorsEmergency + Critical CareCardiologyClient Service RepresentativesDermatologyDiabetesInternal MedicineManagement TeamNeurologyOncologyOphthalmologyRadioactive Iodine Therapy (I-131)Radiology + ImagingRehabilitation & Regenerative MedicineSurgerySynovetin OA
    JOB OPPORTUNITIES
    Join Our TeamInternship, Residency and Externship Programs
    NEWS + EVENTSVIDEOS
207-878-3121
    ABOUT
    EMERGENCY CARE
    OverviewTriage
    SPECIALTY CARE
    OverviewCardiologyDermatologyInternal MedicineNeurologyOncologyOphthalmologyRadioactive Iodine Therapy for Hyperthyroid CatsDiagnostic ImagingRehabilitation & Regenerative MedicineSynovetin OASurgery
    WHAT TO EXPECT
    TEAM
    All DoctorsEmergency + Critical CareCardiologyClient Service RepresentativesDermatologyDiabetesInternal MedicineManagement TeamNeurologyOncologyOphthalmologyRadioactive Iodine Therapy (I-131)Radiology + ImagingRehabilitation & Regenerative MedicineSurgery
    NEWS + EVENTSVIDEOSFEES + PAYMENTCONTACT + DIRECTIONSREFERRING VETERINARIANSPATIENT FORMSONLINE PHARMACYCOVID-19 INFO

Client Information Form

  • Owner

  • Co-Owner / Authorized Agent

  • Method of Payment

  • Payment Policy: Portland Veterinary Emergency and Specialty Care requires a Date of Birth and Driver’s license for all types of payments. Cash, credit cards (Visa, Mastercard, Discover and American Express), Care Credit and Scratch Pay are acceptable forms of payment. No personal, third party, or business checks are accepted.
  • Pet Information

  • Vaccine History

  • Authorization: I (owner or authorized agent for the owner) hereby authorize Portland Veterinary Emergency and Specialty Care veterinarians and staff to examine, prescribe for, and treat the pet described above. Further I understand: That no guarantee of successful treatment is either made or implied. No assurance or guarantee has been made of the results of sedation, anesthesia, surgery and/or treatment and the probabilities of complications exist in any sedation, anesthesia, surgery and/or medical treatment. I assume full responsibility for all charges incurred in the care of said animal and understand all fees must be paid in full upon completion of services and prior to discharge of the animal from Portland Veterinary Emergency and Specialty Care. Should said animal have to be hospitalized or should a surgical procedure be performed, a deposit amounting to 50% of the high end of the estimated fees is required for ALL surgeries and hospitalized patients. Radioactive Iodine Therapy requires payment in full prior to admission. PVESC reserves the right to treat any pet presented with fleas with an oral medication to treat the immediate situation. There is a charge for this treatment. Please Note: If for any reason you are unable to pay your account in full and your account is sent to collection, PVESC reserves the right to add 50% of the balance due to your account to cover collection costs.

  • Clear Signature
  • MM slash DD slash YYYY
  • Clear Signature
  • MM slash DD slash YYYY
  • Information provided is for Portland Veterinary Emergency and Specialty Care use only. No information is disclosed, sold or given to 3rd parties
  • If you are here for an emergency, please call our office after you submit this form and have secured your parking spot. 207-878-3121

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

					            	
    PATIENT FORMSFOR VETERINARIANSPET LOSS SUPPORTCOVID-19 INFO
207-878-3121
FAX: 207-878-0829
    Facebook

Emergency, Surgical + Specialty Services

Emergency Medical Services available 24/7/365

Surgical and Specialty appointment hours are Monday-Friday 8:00AM to 5:00PM

emergency@pvesc.com
specialty@pvesc.com
surgery@pvesc.com
739 Warren Avenue
Portland, ME 04103

Ophthalmology + Dermatology Services

Appointment hours are Tuesday-Friday: 8:00AM – 5:00PM

specialty@pvesc.com
2255 Congress Street
Portland, ME 04102

CARECREDIT

SCRATCH PAY

FEES & PAYMENT

pharmacy iconONLINE PHARMACY
    ABOUTEmergency CareSpecialty CareWHAT TO EXPECTTeamNews + EventsFEES + PAYMENTContactSynovetin OA
©2025 Portland Veterinary Emergency and Specialty Care. All Rights Reserved. Privacy Policy