New Client Enrollment Form

  • Thank you for considering Richmond Valley Veterinary Practice for your pet's needs. 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 ask that you please practice social distancing while in our office. For the safety of our doctors and staff, clients are not permitted to hold their pets during the appointment. Please no food or drink inside the office.
  • Have you ever brought a pet to Richmond Valley Veterinary Practice before?*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • How Would You Prefer To Be Contacted?*
  • Is There a Spouse/Partner/Family Member Who Should Be Listed On Your Account?
  • Format: (000) 000-0000.
  • Is there anyone else (besides above listed contacts) who should be listed on your account, who has ongoing permission to make medical decisions for your pet(s)?
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • How did you hear about us?*
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  • Species*
  • Sex*
  • Is Your Pet Microchipped?*
  • Do You Already Have a Scheduled Appointment?*
  •  - -
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  • Do You Have More Than One Pet At Home?
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  • Species*
  • Sex*
  • Is Your Pet Microchipped?*
  • Do you have more than 2 pets at home?
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Species*
  • Sex*
  • Is Your Pet Microchipped?*
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Species*
  • Sex*
  • Is Your Pet Microchipped?*
  • This form supports telling us about 4 pets in your home. If you have more than 4 pets, please let our office know and we will happily collect information to add them to your account. 

  • Client Policies and Procedures

    We want you to be aware of and understand the following policies and procedures for all clients.
  • 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, Twitter, www.RichmondValleyVet.com and any other marketing and/or other social media outlets we may choose to use?*
  • Richmond Valley Veterinary Practice uses email, text for communications regarding our patient's reminders for health care needs. Do we have your permission to contact you via email, text and regarding these reminders?*

  • 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 and Scratchpay. As financing options are offered through CareCredit and ScratchPay, We cannot offer any 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. Our team is happy to provide any client with an estimate for treatment prior to services being rendered.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 Richmond Valley Veterniary Practice 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.

  • This is a fill in the field. Please add appropriate fields and text.

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