MLVS New Client Enrollment Form

  • Thank you for considering Main Line Veterinary Specialists for your pet's specialty case. 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.  We are located on Rt 30 within Devon Veterinary Hospital. Our address is 81 Lancaster Ave, Devon, PA 19333.

  • Have you ever brought a pet to Main Line Veterinary Specialists or Devon Veterinary Hospital before?*
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  • Contact Information

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  • How Would You Prefer To Be Contacted?*

  • Is There Another Person Or Family Member Who Should Be Listed On Your Account?
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  • Please Tell Us The Relationship With The Above Person, So That We Can Refer To Them Appropriately

  • How did you hear about us?*

  • In Case Of Emergency

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  • Relationship of Emergency Contact

  • Please Tell Us About Your Pet

  • Sex*
  • Species*
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  • Is Your Pet Microchipped?
  • Which Specialty Service Has Your Pet Been Referred To?*
  • Do You Think Your Pet Will Require Anti-Anxiety Medications To Be Given Prior Their Appointment?
  • Has Your Pet Seen Another Specialist In The Past For This Referral?*

  • Are There Another Veterinarian Who Has Treated Your Pet In The Past And You Would Like Reports Sent To?
  • Was Your Pet Seen Here For Emergency Treatment For This Condition?
  • Do You Already Have A Scheduled Appointment?*

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  • Client Policies and Procedures

    We want you to be aware of and understand the following policies and procedures for all clients.
  • Main Line Veterinary Specialists uses email, text and our own hospital app for communications regarding our patient's reminders for health care needs. Do we have your permission to contact you via email, text and/or our app regarding these reminders?*
  • 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 our website, social media (e.g. Facebook, Instagram, Google), and any other marketing outlets?*

  • FINANCIAL POLICY:

    Our office accepts Visa, Mastercard, Discover, and American Express. We also accept cash and checks (only with verification of valid drivers license or other ID at time of payment).

    In addition, we also offer several 3rd party financing options for our clients via Care Credit. 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 every time and that two forms of identification are verified. We appreciate your understanding of our desire to protect your account/identity.

    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. Client will be responsible for a 1.5% monthly finance charge on accounts over 30 days and any collection and/or legal fees on accounts over 90 days. Your signature below indicates your agreement with these policies.

  • TREATMENT CONSENT:

    By signing this document, I declare I am the lawful owner of all listed pets and all information is true and correct to the best of my knowledge. I hereby authorize the veterinarian(s) of Main Line Veterinary Specialists to examine, prescribe for or treat the my pet(s) to the best of their abilities. I assume responsibility for all charges incurred in the care of this animal. I acknowledge that medical information will not be released to anyone not indicated on this form without my express verbal and/or written permission with the except of another veterinary facility.

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