Mountainview Animal Hospital

Alan J. Topal, DVM, P.C.

And Associates

I understand by signing below, if a significant other has been listed, you are giving them permission to authorize treatment to any animals listed on your account in your absence.

ALL PAYMENTS ARE DUE UPON COMPLETION OF VISIT.

Effective open communication and understanding of practice fees and financial policies are vital elements in establishing and maintaining an ongoing professional relationship between you—the client—and us the veterinarians. We want you to understand what you are paying for and the true value of the professional veterinary services that we offer your animals. Some of our fees are predictable and can be quoted fairly accurately prior to seeing a patient. Others, such as those calls requiring emergency services or extensive diagnostic procedures, can only be estimated. We encourage you to ask whichever attending veterinarian you are seeing about the anticipated costs of these necessary procedures beforehand, as to avoid any misunderstandings with respect to the invoice generated.

As the veterinarians at Mountainview, we try to be available and willing to serve your emergency veterinary needs Monday – Friday from closing until 8pm. While some people may consider this availability just part of what it means to be a veterinarian, it is not without great personal effort and sacrifice by our families that we undertake this great obligation to our patients and their owners. As a small business, we have obligations to banks, creditors, suppliers, utility companies, our support staff, and state/federal/local taxation. The only way that we can meet these obligations, continue to provide excellent veterinary services, acquire and pay for new equipment and inventory, and update our skills and stay current through continuing education and additional training, is through following sound business practices. A big part of maintaining a healthy small business is ensuring a steady cash flow. Accounts owing to us from past veterinary work performed may appear fine on paper, but these anticipated funds owed to Mountainview from clients do not pay the current bills. Simply put, we expect timely payment for timely services rendered. This is the only way our small business can operate and survive. It is out of absolute necessity that we outline and enforce the financial policy below.

Client/Patient Form: A fully completed form must be in our files in order for veterinary care to be performed (routine or emergency) on a patient. The information gathered on any and all forms submitted by the client will be strictly confidential and will only be used for the purposes of accurate record keeping and for our billing practices. Those clients wishing to provide us with their e-mail address can be assured it will only be used for reminders, coupons and/or special updates.

Fees are payable at the time of the service rendered. We would like to devote our time to caring for your animal(s), as opposed to managing our billing accounts. We accept payments by cash, checks, Visa, MasterCard, American Express, Discover and Care Credit. Please note that certain invoices may not yet include totals for things like courier fees or additional laboratory tests requested. Once we have received invoices for these services, these additional costs will be sent to the client as a separate invoice at a later date.

Listing any additional person(s) in the spouse/significant other area of our registration form gives them permission to treat any animals on your account in your absence. In the event you decide to remove them from your account at any time, the NYS Veterinary Board requires us to ask for written permission from person(s) to do so.

Billing to Account: Unfortunately at this time, billing on accounts is not permitted.

We do not bill insurance companies. It is the owner’s responsibility to pay for veterinary work carried out, insurance, examinations, etc. We will provide you with the appropriate paperwork to supply to your insurance company.

Collections/Overdue Accounts: We are unable to perform additional veterinary work or dispense any medications for clients who have overdue accounts receivable. Such accounts will either be turned over to collection agency or other legal actions may be undertaken to receive those funds.

If you would like a copy of this financial agreement, we would be happy to give you a copy.

Our goal is to provide quality care for your pets in a timely manner. In order to do so we have implemented an appointment cancellation policy. The policy enables us to better utilize available appointments for our patients in need of care.

Cancellation/No show Policy for Doctor appointments
We understand that there are times when you must miss an appointment due to emergencies or obligations for work or family. However, when you do not call to cancel an appointment, you may be preventing another patient from getting much needed treatment. Conversely, the situation may arise where another client fails to cancel and we are unable to schedule you for a visit, due to a seemingly “full” appointment book.

Clients who fail to show for scheduled appointments or did not notify the office within 24 hours of their appointment time, will be charged a no-show fee of $65. In the event of an actual emergency and prior notice could not be given, consideration will be given, and a one-time exception may be granted.

How to Cancel Your Appointment
If it is necessary to cancel your scheduled appointment, we require that you call 24 hours in advance. Appointments are in very high demand, and your early cancelation will give another pet the possibility to be treated by Dr Topal.

To cancel or reschedule an appointment, please call our office, Mon- Fri, 8:30 a.m. through 4:30 p.m. at (518) 828-1622. You may also cancel/reschedule by using the Pet Desk portal, within 24 hours of your appointment.

Scheduled Appointments
We understand that delays can happen, however, we must try to keep the other patients and the doctor on time. If you are running late, please notify the office.

If a patient is 15 minutes past their appointment time, we have the right to re-schedule your appointment. Please note that these fees are not covered by any Pet insurance and therefore is the sole responsibility of the client. The fee will be added to your account and paid during the next visit/consultation.

I understand by signing below, that I am responsible to contact the office to cancel/reschedule my pets’ appointment within 24 hours or I will be charged a cancellation fee of $70 which I am to pay during my pets next scheduled appointment.