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Patient Information Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pets before your visit.

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You may use the PDF version by clicking the DOWNLOAD FORM button and then completing the printed form by hand. Please bring the completed PDF form with you for your pet’s first appointment.

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WELCOME TO OUR HOSPITAL! We hope that your first visit is a pleasant experience for both you and your pet! In order to ensure this, please review the following hospital policies:

1. Safety
The safety of you and your pet is of utmost importance to us; for this reason, please note the following:

  • All animals are required to be firmly controlled by their owners in the reception and common areas to prevent injury to others. Dogs are required to be on a leash and all cats and other small animals should be in a carrier. These products are available for purchase if needed.
  • You are responsible for the behavior of your pet. Please inform us if your pet has a history of adverse behavior that could result in injury to others.
  • Our staff members will restrain your animal while undergoing examinations by the veterinarian for your safety and ours.

2. All surgical and kennel areas of the hospital are off limits to the public except by special permission or supervised lour. Please initial below if you would like a tour.

3. Boarding
If your pet will be staying overnight for boarding or for any medical reason, the following information must be provided. If you cannot provide such information, we will be happy to try to obtain these records for you. For the safety of your pets, any pets not meeting these qualifications must be vaccinated and/or tested in order to stay in the hospital.
Dogs:
You must provide written evidence that your dog has had:

  • Distemper and Parvovirus vaccinations within the last 12 months.
  • A valid Rabies vaccination.
  • A negative Heartworm examination within the last 12 months.
  • A negative Fecal Examination within the last 12 months.
  • Current Bordetella vaccination if grooming or boarding.

Cats:
You must provide written evidence that your cat has had:

  • Distemper, Leukemia, and Rabies vaccinations within the last 12 months.
  • Feline Leukemia vaccination or evidence of a negative Leukemia test within the last 12 months.
  • A negative Fecal Examination within the last 12 months.

4. Promotions and Returns

  • Promotional Coupons must be presented in advance of services.
  • Only one promotion per visit is accepted.
  • All discounts or promotions will be honored only if accompanied by payment in full at the time of service.
  • New pet boarding and grooming exam fees are only waived upon full payment of other related.
  • Prescription items are non-returnable, and all sales are final.
  • Any accepted returns will incur a 15% restocking fee and will be credited to your account.
  • No cash refunds will be issued.

5. Financial Obligations

  • All vaccinations are accompanied by a physical examination for which there is a charge.
  • Payment in Full is required at the time of services.
  • It is your responsibility to ask for an estimate in advance of services if one is needed.
  • We accept MW/Visa, American Express, Discover, CareCredit, and Scratch Pay.
  • You authorize your credit card and checking account information to be retained and used for payment of any unpaid balance on your account.
  • Unpaid balances may incur an 18% APR finance charge and a $3.50 monthly statement fee.
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