Client/Patient Registration Form

Client Policies and Procedures

We want you to be aware of and understand the following policies and procedures for all clients.
We Love Social Media! Do we have your permission to post pictures of your pet(s), you and your pet(s) and/or your pet(s) and our team on Facebook, Instagram, Twitter, www.poulsbomarinavet.com and any other marketing and/or other social media outlets we may choose to use? *

Yes No
I am the owner / agent of the owner of the animal identified above, and do hereby consent and agree that Poulsbo Marina Veterinary Clinic, its employees, or agents have the right to take photographs, videotape, or digital recordings of my pet and to use these in any and all media, now or hereafter known, and exclusively for the purpose of putting pictures of our patients on our website, marketing materials, social media, and within our newsletter. I further consent that my pet's name and identity may be revealed therein or by descriptive text or commentary. This consent remains in full force and effect unless and until I provide a written revocation of the consent. I do hereby release to Poulsbo Marina Veterinary Clinic, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately. I waive any rights, claims, or interest I may have to control the use of my pet’s identity or likeness in whatever media used. I understand that there will be no financial or other remuneration for recording my pet, either for initial or subsequent transmission or playback. I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.
Initial
I confirm that I am over the age of 18 years old. (initial below) *
Initial
Poulsbo Marina Veterinary Hospital uses email, text and our own hospital app for communications regarding our patient's reminders for health care needs. Do we have your permission to contact you via email, text and/or our app regarding these reminders? *

Yes No
Poulsbo Marina Veterinary Clinic no longer provides reminders for appointments or services due by mail. If you choose not to be contacted by email, text and/or our hospital app, we cannot guarantee timely reminders regarding your pet(s) health. If choosing not to provide permission to contact you digitally, please initial below indicating that you understand the above and release Poulsbo Marina Veterinary Clinic from any liability surrounding notification (timely or otherwise) regarding your pet(s) health care needs. *
Initial
FINANCIAL POLICY:

Our office accepts Visa, Mastercard, Discover, and American Express. We also accept cash and checks (only with verification of valid drivers license or other ID at time of payment).

In addition, we also offer several 3rd party financing options for our clients via Care Credit and Scratchpay. We accept a variety of Care Credit plans based on the total transaction amount for your pet. Care Credit requires that payment only be made for services as they are rendered, we cannot charge services to your account in advance. Therefore, Care Credit cannot be used for PAW plan services. Additionally, use of Care Credit requires that the card be present every time and that two forms of identification are verified. We appreciate your understanding of our desire to protect your account/identity.

As financing options are offered, we cannot offer additional in-house payment plans for our services. Clients needing additional financial support are encouraged to apply for Care Credit with a co-signer.

Full payment is due at the time of service. This includes any charges/fees agreed to by my authorized proxy. Our team is happy to provide any client with a written treatment plan prior to services being rendered. Client will be responsible for a 1.5% monthly finance charge on accounts over 30 days and any collection and/or legal fees on accounts over 90 days. Your signature below indicates your agreement with these policies.
*

Clear
Should be Empty:

IMPORTANT:

Client Policies and Procedures