New Client Form

We'd love to get to know you and your pet better, please fill out this form before your first appointment with us.

If you have any questions, please call us at (540) 667-4290.

Agreement

Effective July 1, 1991, the Commonwealth of Virginia passed a law that requires all non-24 hour animal care facilities to disclose the hours that medical staff is not on duty. The law applies to any situation where there is a possibility that your pet may stay in the hospital overnight for any period of time. The law also REQUIRES that we maintain a sign where indicated.
Thank you.

NO medical staff is on duty from 7:00pm Monday to 7:00am Tuesday, 7:00pm Tuesday to 7:00am Wednesday, 7:00pm Wednesday to 7:00am Thursday, 7:00pm Thursday to 7:00 am Friday, 6:00pm Friday to 8:00am Saturday, and 1:00 pm Saturday to 9:00 am Monday. NO medical staff is on duty on Holidays. I understand there is an emergency clinic open during those hours when the Hospital is closed and that, if needed, I will make the necessary arrangements to have my pet transferred.

To the best of my knowledge, the information provided to this office is complete and accurate. I acknowledge that ALL charges incurred in this office are my responsibility. I agree to be responsible and to pay for all services performed
by this office. I understand that if my account remains unpaid by me for a period of 30 days, it may be referred to
an attorney for collection, and that I further agree to be responsible and pay for all costs incurred, including 35% attorney’s fees (minimum of $75.00) and interest at 1.5% per month (18% per annum).

I have read this form in its entirety and I am aware of the staffing hours, listed above.