Client Profile Update Form

Client Profile Update Form

Thank you for choosing High Country Veterinary Services for your equine partners. This form is used to update your existing client information. Please complete the fields below with any changes or confirmations.
Client Name
Phone Number
Email
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Please update any individuals authorized to make medical decisions for your animal(s). Include full name and phone number below if there are any additions or changes.
Have there been any changes to your horses since your last update (e.g., new horses added, horses sold, re-homed, or passed away)? If yes, please provide details below.
- Name
  
  Barn NameOfficial/Registered Name (if applicable)
- Approximate Age
- Breed
- Gender
- Color
- Horse Location
- Horse Location Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- This horse will be archived and will no longer show up on your Client account
- Name
  
  Barn NameRegistered/Official Name
- We are deeply sorry for the loss of your companion. This horse will be respectfully archived in your account and removed from your active records, and any associated reminders will be discontinued.
- Name
  
  Barn NameRegistered/Official Name
- General Care Serivces and Treatment Authorization
- I authorize the veterinarians and staff of High Country Veterinary Services, LLC, to perform examinations, give treatments, perform diagnostics and give prescriptions for non-urgent situations where I or my authorized agents have made an appointment for said animal, and have verbally given consent to treat during the appointment. I understand I am responsible for all costs incurred and will comply with High Country Veterinary Services, LLC’s financial and payment policies.
- I authorize the veterinarians and staff of High Country Veterinary Services, LLC to examine my animal and perform necessary diagnostics and treatments in emergency situations were I cannot be reached. Our team will always make reasonable attempts to contact you by phone or in person, however, in certain circumstances where it is in the humane interest of the animal or patient, this may not be possible.
- At Time of Service Policy
- High Country Veterinary Services requires payment in full at the time services are rendered. This policy applies to all clients and helps ensure we can continue providing timely, high-quality care.
  
  Payment will be processed at the time of the visit unless alternative arrangements are approved in advance, and sufficient funds must be available. We accept cash, check, ACH bank transfer, and major credit cards (Visa, MasterCard, American Express, Discover).
  
  All clients are required to keep a valid credit or debit card on file, which may be used to process payment for services, late cancellations, missed appointments, or any outstanding balances if payment is not otherwise completed. Outstanding balances may be required to be settled before additional services, including emergency care, are provided, at the discretion of the veterinarian or management.
  
  We use secure systems to protect your payment information. Questions about this policy can be directed to (970) 749-1013.
- I Agree to HCVS's At Time of Service Policy
- Credit Card Fee
  
  I understand the cost of credit card processing fees is 2% in accordance with 5-2-212, Colorado Revised Statutes, and clients will now be responsible for all fees associated with credit card payments by our payment processor. To avoid these fees you can pay by cash, check or debit card at time of service. ACH payments are available through our web payment link. If you choose to pay via ACH bank transfer please inform the team so the credit card on file is not charged.
- Cash Payment
- Failure to Pay
  
  I understand my failure to pay outstanding invoices will result in a charge of $25 per invoice outstanding for every 7-day period* the balance remains overdue. Accounts that remain unpaid after 60 days may be referred to a collections agency and/or result in termination of the veterinarian-client patient relationship (VCPS). Any costs associated with collection efforts will be the responsibility of the delinquent party. In addition, no further services will be provided while there is an unpaid balance on the account. *Does not include Large Ranch Billing or other payment plans in place as separate agreements have been put into place.
- Additional Fees
  
  Some additional fees are associated with your vet visit. These fees, in order to be transparent, guarantee our ability to keep the clinic and trucks stocked with appropriate medications and supplies, equipped with necessary diagnostic tools, vehicle maintenance and routine safety checks, and staffed with an enthusiastic and passionate team of dedicated employees.Additional Fee can include and are not limited to: Biohazard Disposal Fee; Temporary Fuel Surcharge fee; catch fee; day stall use fee; feed delivery fee; HCVS equine transportation fee; injection or administration fee
- Emergency Services Authorization
  
  Our emergency services guidelines and policies are on our website for your viewing. Emergency fees are associated with all urgent appointments, day and night, to off-set the costs of rescheduling other appointments during the day and providing emergency services after business hours, on weekends, and holidays.
- In life-threatening situations where recovery is not reasonably possible and continued suffering is likely, I authorize the attending veterinarian to perform humane euthanasia. Examples may include, but are not limited to, severe trauma from a motor vehicle accident, catastrophic and non-survivable colic that cannot be safely transported for referral care, or severe fractures and injuries causing extreme pain, shock, and an unrecoverable prognosis.
- Signature
- Today's Date
  
  MonthDayYear
  Date
Should be Empty:

Client Profile Update Form

General Care Serivces and Treatment Authorization

At Time of Service Policy