Providence Animal Hospital Client Form

  • Thank you for choosing Providence Animal Hopistal & Pet Resort for your pet's needs. Please fill out our new client/patient registration form in entirety to ensure we can provide you and your pet with the best possible care.
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  • Is There a Spouse/Partner/Family Member Who Should Be Listed On Your Account?*

  • 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?*
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  • Do You Have More Than One Pet At Home?*
  • Browse Files
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  • Species
  • Sex
  • Is Your Pet Microchipped?
  • Do you have more than 2 pets at home?
  • Browse Files
    Cancelof
  • Species
  • Sex
  • Is Your Pet Microchipped?

  • 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.providenceanimalhospital.com and any other marketing and/or other social media outlets we may choose to use?*
  • Providence Animal Hospital & Pet Resort uses email and text for communications regarding our patient's reminders for health care needs. Do we have your permission to contact you via email, text and/or regarding these reminders?*

  • FINANCIAL POLICY:

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

    In addition, we also offer a 3rd party financing option for our clients via Care Credit. 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. Additionally, use of Care Credit requires that the card be present at each visit it used. We appreciate your understanding of our desire to protect your account/identity.

    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. Your signature below indicates your agreement with these policies.

  • Cancellation Policy

    When we book an appointment for you, we reserve time and staff just for you and your pet. We understand that situations do arise from time-to-time therefore, we require a minimum of 24 hours notice to cancel an office appointment and 48 hours notice to cancel any surgicial procedure including dentals. If you are unable to provide proper notice for cancellation(s), Providence Animal Hospital may require prepayment to book future services.

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