New Client Registration

New Client Registration
Owner Name*

First NameLast Name
Co-Owner Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Primary Owner Cell Phone Number*

Area CodePhone Number
Co-Owner Cell Phone Number

Area CodePhone Number
Home/Work Phone Number

Area CodePhone Number
When contacting you regarding prescription refills, are text notifications acceptable?

YesNo
Driver's License Number
Please take photo of Driver's License for our records
Employer Name/ Address
Co-Owner Employer Name/ Address
How did you hear about us?

GoogleYelpFacebookInstagramOtherReferred by employeeOther
Patient Name*
Gender*
Gender*

MaleFemaleUnknown
Spayed/Neutered?

YesNo
Age/ Date of Birth*
Species*
Breed*
Color*
Previous Veterinary Hospital
PHOTO CONSENT: I authorize Oasis Veterinary Hospital to take and display photos of my pet(s) on their social media sites: website, Facebook, Instagram, Twitter, etc and/or internal media site and marketing materials.*

YesNo
Vaccinations

Oasis Veterinary Hospital requires verification of veterinarian administered vaccination of the following prior to admittance for hospitalization, surgery, and/or boarding:

Canines: Distemper/Parvo, Bordetella(Kennel Cough), Rabies
Felines: Distemper, Rabies
Signature*

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TERMS AND CONDITIONS

ALL FEES ARE DUE UPON COMPLETION OF SERVICES. I understand that all fees are due and payable when services are rendered. An estimate may be provided upon request prior to pets receiving medical treatment in office or for hospitalization. Account balances which are not paid within 10 days of the date of the invoice become delinquent and are subject to a 2% monthly finance charge. I agree I am financially responsible for attorney’s fees and all other costs related to collection, including but not limited to all applicable court costs.

Oasis Veterinary Hospital requires a scheduling fee for new clients, clients who have missed three appointments, and all surgery bookings. For office visits, the fee is applied to the final visit cost and refundable if canceled 24 hours in advance, otherwise forfeited. For procedural consultations, the fee is credited to the procedure's cost and refundable if canceled 24 hours in advance, otherwise forfeited. For surgeries, the fee is credited to the procedure’s cost, refundable with 48 hours' cancellation notice, and forfeited otherwise. If you arrive more than 10 minutes late for an appointment without notice, you may be marked as a no-show which could result in a reschedule on all or part of you and your pet’s scheduled service(s) and forfeiture of the scheduling fee.
Acceptance*

I agree to the terms and conditions of service.
Signature*

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Oasis Veterinary Hospital

(804) 348-8808
PLEASE READ BEFORE SIGNING.

As of July 1st, 1991 all veterinary hospitals in the Commonwealth of Virginia must have the following form signed for any animals seen or kept during the day or overnight, for medical treatment, grooming or medically supervised boarding at our facility. Medical personnel are on duty only during the following hours.
Hours of Operation:

Monday 8AM–6PM

Tuesday 8AM–6PM

Wednesday 8AM–6PM

Thursday 8AM–6PM

Friday 8AM–6PM

Saturday 9AM–1PM

Sunday Closed
Animals hospitalized or boarding during the weekends or closed holidays will be visited by hospital staff once in the morning, and once in the evening.
The hospital is not staffed at any other time.

I have read and understand when Oasis Veterinary Hospital is
staffed.
Signature*

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New Client Registration

Oasis Veterinary Hospital