UCVC New Client Form

New Client Information Form
Owner Information
Name*

TitleFirst NameLast Name
Email*
example@example.com
Primary/Cell Phone*
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Office Phone
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Zip Code*
CO-Owner Information (optional)

Another person you are authorizing to speak for your feline friend(s)
Name

First NameLast Name
Relationship

SpousePartnerOther
Email
example@example.com
Cell Phone
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Office Phone
Please enter a valid phone number.
Employer Information

This information is optional, but will be required if you wish to pay with a check.
Place of Work

Financial Policy
Written estimates will be provided for all recommended medical and surgical procedures.

Thank you for choosing Uniquely Cats Veterinary Center. Our primary mission is to deliver the best and most comprehensive veterinary care available for your cat. An important part of the mission is making the cost of optimal care as easy and manageable for our clients as possible by offering several payment options. Uniquely Cats Veterinary Center requires payment in full at the end of your cat's examination and/or at the time of discharge.

Payment Options:
You can choose from:
- Cash, Visa®, MasterCard®, American Express®, Discover Card® or personal check
- Convenient Monthly Payment Options from CareCredit®
  - Allow you to begin treatment today and pay over time
  - Available for any treatment amount
  - Can be used repeatedly - for your entire family - without having to reapply
- Scratchpay Loan Options
For some treatments or hospitalized care, a deposit may be required. Healthcare plans requiring comprehensive care of more than $500 will require a 50% deposit to begin your cat's treatment.

Additional Policy Information:
Uniquely Cats Veterinary Center charges $35 for returned checks. A fee of $50 may be charged for clients who miss or cancel more than 2 appointments in a calendar year without 24 hours notice. For clients with pet insurance, we are happy to provide you with the necessary documentation to submit a claim to your insurance carrier.

If you have any questions, please do not hesitate to ask.

We are here to provide the best veterinary care available for your furry friend.
Financial Policy Acknowledgement*

I have read and understood the financial policy
Client code of Conduct
Uniquely Cats Veterinary Center seeks to continually provide a welcoming and safe environment that ensures trust and respect for all people and cats. We strive to treat every client and patient with kindness, respect, and compassion. Our goal is to create a working relationship with the shared goal of compassionate veterinary care for your cat.

To preserve this relationship, we ask that you DO the following:
- Disclose relevant, accurate, and complete information about your cat’s temperament, health, and history.
- Visit at least once per year to maintain a valid veterinary-client-patient relationship as is required by law to dispense medications including flea and heartworm prevention.
- Treat other clients, patients, and personnel with respect.
- Meet financial obligations.
- Recognize the reality of risks and limits of the science of veterinary medicine.
- Work collaboratively with providers to develop and carry out agreed-upon treatment plans.
- Address the Hospital Manager with any issues that may arise and clearly communicate your wants and needs.
To preserve this relationship, we ask that you REFRAIN from the following behaviors:
- Verbal abuse, malicious or harmful statements about others, profanity or disrespect.
- Any form of harassment.
- Discriminatory comments or actions.
- Intimidation tactics and/or making threats.
- Allowing your cat to intimidate or threaten a person or another cat.
- Public disclosure of another’s private information.
- Being under the influence of alcohol or behavior-altering drugs.
- Failure to comply with requests of our staff, including putting your cat in a carrier.
In the event that your behavior is problematic, we reserve the right to terminate our relationship and discontinue services immediately. Non-compliance will result in corrective measures being taken, which may include being asked to leave the property and the possible involvement of law enforcement. Thank you for your cooperation and understanding we look forward to working together for the health of your cat.
Client Code of Conduct*

I have read and agree to the Client Code of Conduct policy
Agreement And Signature

After signing, you will receive an electronic PDF copy of the agreement document at the supplied email address.
Signature

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New Client Information Form

Owner Information

CO-Owner Information (optional)

Employer Information

How did you hear about Uniquely Cats Veterinary Center?

Kids and Pets

Use of Name and Pictures

Financial Policy

Client code of Conduct

Agreement And Signature