Wellness Plan Sign Up Form

Wellness Plan Sign Up Form

At Cape Coral Pet Vet, our goal is to help keep your pet happy and healthy. Preventative care is the cornerstone to making this possible. Every year we detect many disease processes in apparently 'normal' animals. Early diagnosis and appropriate treatments can result in your pet living a longer healthier life. With our wellness plans, you'll experience peace of mind knowing that they will receive the veterinary care they need to keep them healthy and happy, while reducing your costs. For more information please go to http://capecoralpetvet.com/wellness-plans . To signup for our wellness plans, please fill out this form.
Your Name *

First Name Last Name
Email *
example@example.com
Available Monthly Wellness Plans:

A. $50.00 monthly for a Puppy or Kitten Monthly Plan

B. $30.00 monthly for an Adult Dog or Adult Cat Plan.

C. $50.00 monthly for a Senior Dog or Senior Cat Plan.

Optional Monthly Add-ons Per Pet (if wanted) :

A. $5.00 per month for monthly scheduled nail trims. *Maximum of 10 nail trims per 12 months.

B. $20.00 per month for dental cleaning, full mouth radiographs evaluation.

For more information please go to: Pet Vet Wellness Plans
Pet #1 Name: *
Pet Name
Select a Wellness Plan for Pet #1 *
Add-ons Pet #1 (Optional)

Nail Trims ($5) Dental Cleaning ($20)
Pet #2 Name:
Pet Name
Select a Wellness Plan for Pet #2
Add-ons Pet #2 (Optional)

Nail Trims ($5) Dental Cleaning ($20)
Pet #3 Name:
Pet Name
Select a Wellness Plan for Pet #3
Add-ons Pet #3 (Optional)

Nail Trims ($5) Dental Cleaning ($20)
Pet #4 Name:
Pet Name
Select a Wellness Plan for Pet #4
Add-ons Pet #4 (Optional)

Nail Trims ($5) Dental Cleaning ($20)
Payment Terms:
1. Initial Setup Fee: $50.00 one time setup fee per account. **Will cover all pets setup at the same time.
2. First months payment is due at the time of set-up.
3. Monthly payments will be drafted on the date of the wellness plan sign up.
Cancellation and Transfer Terms:
1. In the event a pet is lost or stolen, passed away or you decide to cancel the plan you will be given the option to pay for the services rendered at full price or continue to pay your monthly installments until the end of your annual term, whichever is less.
2. If I choose to cancel before my contract is over (12 months), I understand there is a $35.00 cancellation fee. I will also be responsible for all services performed at full cost. No credit will be given for any payments received.
3. Plans are transferable to new pet owners. The new owner will be responsible for the remainder of the plans payments plus a one-time $50.00 set up fee.
Your Plan Totals
Wellness Plan(s) Amount $:
Add-on(s) Amount $:
Total Monthly Amount Due $:
(Optional) I wish to pay in full for my pet’s wellness plan instead of monthly payments.

Yes I want to pay in full instead of monthly payments.
My Full Term Commitment $:
I have read the terms and conditions of each plan I am signing up for and I understand that I am entering into a 12 month agreement, freely and voluntarily. I am the owner or authorized agent of the above pet(s). I understand that financial terms will be governed by Cape Coral Pet Vet. If my payment is declined for any reason, my services will be suspended until the account is brought back current. Services offered during the term of this plan do not roll over to future renewals, nor may services offered under this plan be utilized after the expiration of this plan. This plan will auto-renew for a new term every 12 months, unless I contact Cape Coral Pet Vet in writing 30 days before the plan is set to auto renew.
I agree to above terms & conditions *

Clear
Date *

Month Day Year
Date
Should be Empty:

Wellness Plan Sign Up Form

Your Plan Totals