Campbellford Veterinary Services Client Enrollment Form

  • New Client Application

    Thank you for considering Campbellford Veterinary Services 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. A staff member will contact you if your application has been approved.
  • Have you ever brought a pet to Campbellford Veterinary Services before?*
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  • Does this phone accept text messages?
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  • Is There a Spouse/Partner/Family Member Who Should Be Listed On Your Account?
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  • In case of emergency...

  • 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)?
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  • How did you hear about us?*

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  • Species*
  • Sex*
  • Is Your Pet Microchipped?*
  • What is the first appointment type you need to schedule for your friend? (check all that apply)*

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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
    Cancelof
  • Species*
  • Sex*
  • Is Your Pet Microchipped?*
  • Browse Files
    Cancelof
  • Species*
  • Sex*
  • Is Your Pet Microchipped?*

  • This form supports telling us about 3 pets in your home. If you have more than 3 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.
  • At Campbellford Veterinary Services, we recommend regular examinations, vaccinations, commercially prepared balanced pet foods, parasite prevention, regular dental hygiene procedures, and, when needed, collaboration with board-certified veterinary specialists to ensure your pet receives the very best care. Please select one of the following options.*

  • Photo/Name Release: Campbellford Veterinary Services likes to use images of our client's pets to demonstrate the care and attention that they receive here. When pets are happy and calm during treatment and care, it helps other pet owners to see how enjoyable veterinary care can be. We will never share images of pets during the last moments of their lives, and we use discretion in the images taken and shared. We only use pet names and not owner names in our content. By signing below, I hereby give Campbellford Veterinary Services the right to use the name, video, and photographs of any of my pets in connection with its website and any promotional materials in any and all media, including, but not limited to, printed material, internet, social media, and film for display, public relations, and marketing. I hereby acknowledge receipt of adequate consideration and waive the right (i) to charge or be compensated for the use of the pictures, and my pet(s)'s name(s), and (ii) to inspect or approve the images prior to any form of usage. I understand that the images my be modified to use as design elements*

  • Professional fees are due in full at the time of services rendered.

    Payment Options: Cash, checks, debit cards, VISA and MasterCard.

    Deposits: Non-refundable deposits are required for first new client visits, and anesthetic procedures/surgeries. Typically these will be equivalent to your appointment charge, or a percentage of the surgical procedure.  Deposits will be applied to your invoice on the day of your appointment. Should you fail to cancel an appointment with greater than 24 hours  (72 hrs for anesthesia/surgery appointments) the deposit will serve as your cancelation fee.

    Estimates: At your request, we will gladly discuss the cost of services and/or prepare a written estimate for recommended procedures and treatments. Our goal is to provide your pet with thorough care that also fits your family's needs. We believe in recommending the best for your pet and your family - if you desire an estimate, please request one before authorizing procedures being performed.

    Cancelled Appts: We ask that if you must cancel or reschedule your appointment, you do so greater than 24 hours of your appointment (72 hrs for anesthesia/surgery appointments). With the exception of emergency, management deemed extenuating circumstances all appointments that are canceled or rescheduled within 24 hrs of the appointment time (72 hrs for anesthesia/surgery appointments) or are no shows will be assessed a cancellation fee. The cancellation fee must be paid in full before rescheduling the next appointment in these situations.

    Returned Checks: We charge a $60 fee for returned checks. This returned check charge and the client balance must be paid in full before scheduling any further appointments.

    Failure to Pay: In the event you refuse or otherwise fail to make payment owed for services rendered by us in caring for your pet, you are responsible for any and all costs of collection incurred by us, including attorney's fees, to collect payment(s) from you. 

  • Campbellford Veterinary Services uses email and text for communications regarding our patient's reminders for health care needs. Do we have your permission to contact you via email and text regarding these reminders?*

  • FINANCIAL POLICY:

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

    In addition, we also have a 3rd party financing option for our clients via Petcard. 

    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 financing through Petcard .

    Except for our Wellness Plans, full payment is due at the time of service.

    Your signature below indicates your agreement with these policies and procedures.

  • 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 Campbellford Veterinary Services 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 exception of another veterinary facility.

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