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Information about you and your pet!
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Spouse or Secondary Owner:
Please complete information for all of your pets - Thank you!
In this document, “Patient” refers to any pet receiving treatment. “Client” refers to any person(s) acting on behalf of the Patient. Use of the word “I”, “you”, “your” or “me” refers to the Client.
“Provider” refers to the hospital and the hospital’s staff, which include but are not limited to: other licensed independent practitioners and any authorized agents, contractors or affiliates acting on their behalf.
4. Consent to Photograph and Video. I hereby permit Provider, its representatives and employees the right to take photographs of my pet, edit, use and publish in print or electronically. I agree the Provider may use such photographs of my pet with or without our name and for any lawful purpose, including publicity, illustration, advertising and web content. (Please select consent below).
6. No Show/ Late Cancellation Policy. Clients who miss or cancel an appointment without 24 hours notice will be subject to a No Show fee of $56.99. Prepayments are required for any new client, clients with a history of multiple cancellations, surgical or imaging appointments, or any client who has not actively been seen in our office within the last 12 months, therefore, if a client is to cancel that appointment, the cost is non-refundable. This fee will not be placed on the Clients account to use towards future service(s). It is the responsibility of the client to pay any outstanding fees prior to scheduling their next appointment.
This policy has been established in order to provide the highest level of veterinary care to all of our patients. By providing us with a notice of cancellation, we may be able to accommodate other patients with that time slot. We do understand that emergencies arise and that it may not be possible to give such notice. Exceptions to this policy will be determined by management.
7. Financial Agreement. In consideration of the services to be rendered to Patient, Client or Guarantor individually promises to pay the Patient’s account. An estimate of the anticipated charges for services/procedures/medications, etc. will be provided before services are rendered. Estimates may vary from the final charges based on a variety of factors including, but not limited to, the course of treatment, intensity of care and the necessity of providing additional goods and/or services.
I understand a deposit may be required for exams, procedures, diagnostics, surgeries, medications, etc. I also understand that the outcome of care does not change the Client’s obligation to pay for services.
All payments are due before any services will be rendered.
Once all laboratory tests are submitted and services are rendered the fee paid is non-refundable for all tests and services.
Acknowledgement. I hereby warrant and represent that I am the owner of Patient(s). I am 18 years of age or older and have carefully read through all terms and conditions. By signing, I agree to all terms and conditions as mentioned in this document.
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