SPV New Client Form

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 Facebook, Instagram, and any other marketing and/or other social media outlets we may choose to use?*

YesNo

If you'd like to be tagged in any social content containing your pet, please provide your social handle.

@your_name

Does your pet have insurance?*

YesNo

Name of provider?

I agree to release Southpaw Vet from all claims for libel, slander, invasion of privacy, infringement and copyright or right of publicity or any other claim and confirm that you are over the age of 18 years old. (initial below)*

Initial

Southpaw Vet 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?*

YesNo

If you choose not to be contacted by email or text, we cannot guarantee timely reminders regarding your pet(s) health. If choosing not to provide permission to contact you digitally, please initial below indicating that you understand the above and release Southpaw Vet from any liability surrounding notification (timely or otherwise) regarding your pet(s) health care needs. *

Initial

FINANCIAL POLICY: Our office accepts cash, Visa, Mastercard, Discover, and American Express. In addition, we also offer several 3rd party financing options for our clients via Care Credit. We accept a variety of Care Credit plans based on the total transaction amount for your pet. Care Credit requires that payment only be made for services as they are rendered, we cannot charge services to your account in advance. Therefore, Care Credit cannot be used for Puppy/Kitten Package services. 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. As financing options are offered, we cannot offer additional in-house payment plans for our services. Clients needing additional financial support are encouraged to apply for Care Credit with a co-signer. 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 hereby authorize the veterinarian(s) of Southpaw Vet 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.

Owner Information

Pet Information

Client Policies and Procedures