Fields marked with * are mandatory. All other fields are optional and do not need to be filled in.

Please enter your telephone and mobile number separately with the country code (+49 for Germany) and the phone number.

Fields marked with * are mandatory. All other fields are optional and do not need to be filled in.

Please note that you may have to pay bills to a pet insurance company first.

For the proper medical treatment of your animals and the billing thereof, it is necessary to store certain personal data. We therefore ask for your consent as set out below.

As the animal owner, I hereby consent to the veterinary practice storing and using the following data for the purpose of providing the best possible care:

• my address,
• my contact details (e.g. telephone number, email address),
• data relating to the treatment of my animals, and
• records of curative treatments and administered medications.

I consent to my data being disclosed, where necessary, to:

• external laboratories,
• external service providers required for billing purposes (e.g. billing or clearing agencies),
• pet registries (e.g. TASSO),
• other veterinary practices in the event of a referral, and
• external service providers for the purpose of communication with the practice.

Beyond this, any disclosure of data to third parties shall only take place within the scope permitted by law and, where applicable, only with my renewed consent.

I further consent to:

• being informed by the practice about upcoming vaccinations for my animals, and
• receiving current information from the practice.

I may request information at any time about the scope of the data stored.
I have been informed that this declaration is given voluntarily and that I may revoke it at any time. In this case, any data already collected will be deleted.

I hereby confirm that I am the owner of the animals that I present to this practice and am therefore authorized to enter into a contract for the performance of necessary examinations, treatments, and surgical procedures. This declaration applies to all animals that I currently or in the future present or arrange to be presented to this practice. I further confirm that I am willing and able to bear the costs arising from such examinations and treatments. I also declare that, at the time of making this declaration, I am not subject to any judicial insolvency or debt proceedings. If I am not the owner of an animal presented, I confirm that I am acting with the express authorization of the animal’s owner. If such authorization is not present or if the owner disputes the existence of such authorization, I hereby confirm that I will personally be responsible for the costs arising from the treatment. To the extent necessary for diagnostic or treatment purposes, I authorize the practice to commission services from third parties (such as laboratory examinations) in my name and on my account.

I confirm that the information provided by me is accurate and I hereby instruct the practice to examine and/or treat the animals presented by me. I confirm that I am authorized to do so. I acknowledge that the costs incurred for the examination and/or treatment of the animal are to be settled immediately after the examination or treatment in cash, by debit card, or by credit card.

This declaration and the treatment contract established hereby apply to all animals that I present to this practice, including any follow-up treatments.

By signing, I agree to the treatment contract and to the presented data protection consent declaration within the scope of its intended purpose.