KVH New/Patient Client Form

  • Client / Patient Registration Form

    Thank you for considering Kitsap Veterinary Hospital for your pet's health and wellness care. Please fill out our new client/patient registration form in its entirety to ensure we can provide you and your pet with the best possible care. Please call us with any questions ph. 360-876-2021. We are located at 3036 Bethel Rd. SE in Port Orchard

  • *DATA PRIVACY*

    Please understand that we take the security of your information extremely seriously and will not under any circumstances share, sell, or disceminate your information for any reason. We will only share information after receiving consent from the primary owner on each account. From time to time we may reach out to you regarding your pet(s) wellbeing or to communicate an urgent message. Please indicate your communication preference below.

  • Have you ever brought a pet to Kitsap Veterinary Hospital before?*
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  • How Would You Prefer To Be Contacted?*
  • In the event your pet(s) would need controlled substances as part of treatment, we are required to have the primary account holder's date of birth on file.*
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  • Is There a Spouse/Partner/Family Member Who Should Be Listed On Your Account?
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  • In case of emergency...

  • Is there anyone else (besides above listed contacts) who should be listed on your account, who has ongoing permission to make medical decisions for your pet(s)?
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  • How did you hear about us?*
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  • Species*
  • Sex*
  • Is Your Pet Microchipped?*
  • Do You Already Have a Scheduled Appointment?*
  • Appointment Date *
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  • Do You Have More Than One Pet At Home?*
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  • Species*
  • Sex*
  • Is Your Pet Microchipped?*
  • Do you have more than 2 pets at home?
  • Browse Files
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  • Species*
  • Sex*
  • Is Your Pet Microchipped?*
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  • Species
  • Sex
  • Is Your Pet Microchipped?

  • This form supports telling us about 4 pets in your home. If you have more than 4 pets, please let our office know and we will happily collect information to add them to your account. 

  • 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.kitsapvet.com and any other marketing and/or other social media outlets we may choose to use? *
  • Kitsap 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? *

  • FINANCIAL POLICY:

    Our office accepts Visa, Mastercard, Discover, American Express, and cash.

    New clients are required to put a deposit on account for their first appointment. This deposit will used towards payment of the final costs of your visit. If you do not notify us 24 hours prior to the appointment that you wish to cancel or reschedule or you no show for your appointment, your deposit will be forfited.

    In addition, we also offer several 3rd party financing options for our clients via Care Credit. We accept Care Credit's 6 month payment plan for the total transaction amount for your pet's care. 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 3.0% 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.

  • Are you active or retired military? Please let use know as we offer a military discount. Thank you!

  • TREATMENT CONSENT:

    By signing this document, I declare I am the lawful owner of all listed pets and all information is true and correct to the best of my knowledge. I hereby authorize the veterinarian(s) of Kitsap Veterinary Hospital to examine, prescribe for or treat the my pet(s) to the best of their abilities. I assume responsibility for all charges incurred in the care of this animal. I acknowledge that medical information will not be released to anyone not indicated on this form without my express verbal and/or written permission with the except of another veterinary facility.

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