Veterinary New Client Registration 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, www.kbayvet.com and any other marketing and/or other social media outlets we may choose to use?*

YesNo

I agree to release Kachemak Bay Animal Hospital 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

Kachemak Bay Animal Hospital uses email and/or text for communications regarding our patient's reminders for health care needs. Do we have your permission to contact you via email and/or text regarding these reminders?*

YesNo

Kachemak Bay Animal Hospital does not provide reminders for appointments or services due by mail. If you choose not to be contacted by email and/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 Kachemak Bay Animal Hospital from any liability surrounding notification (timely or otherwise) regarding your pet(s) health care needs. *

Initial

FINANCIAL POLICY:

Our office accepts Visa, Mastercard, Discover, and American Express and cash.

In addition, we also offer several 3rd party financing options for our clients via Care Credit and Scratchpay. 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 Wellness plan services. Additionally, use of Care Credit requires that a form of identification is 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 always 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.

OUTSIDE PHARMACY POLICY:

For your convenience, we have an on-site pharmacy comprised of the medications we commonly prescribe. Should you prefer, we will gladly provide a written prescription, which you can take or mail to an outside pharmacy.

To avoid errors, we will not fill prescriptions to online pharmacies by phone, fax or online portal; you must mail the original prescription directly to them. Our practice does not directly communicate with outside online pharmacies, the exception being special order or compounded medications.

In order for us to provide you with a prescription - federal and state laws require a valid veterinarian-patient-client-relationship. A complete physical exam of your pet by the veterinarian will be necessary every six to twelve months depending on age, health condition and medication.

Please allow at least 48-72 hours for prescription refill requests or issuance of a written prescriptions.

APPOINTMENT POLICY:

Appointments:

To allow ample time for all patients and scheduled surgical procedures, we operate primarily by appointment. Emergency cases are our highest priority and can on occasion cause a delay or rescheduling to scheduled appointments. We make a sincere attempt to see each client and pet on time.

For the safety of all animals in our care, we ask you to restrain your pet. We require that all dogs and cats be placed on a leash or in pet carriers before entering the waiting room.

Late Appointments:

If you are running late for an appointment, please contact our office as soon as possible at (907) 235-0143. Arriving more than 10 minutes after your scheduled appointment time, may result in the need to reschedule to a later date or time.

No-show Appointments:

Please give us the courtesy of 24 hour cancellation notice. If you do not give us advance notice of a cancellation we may require a non refundable deposit prior to rescheduling. Most routine scheduled surgeries are subject to a $50 non-refundable scheduling fee. This fee will count toward your final bill on the day of the procedure and will not be refunded in the event you fail to to notify us or wish to reschedule/cancel a surgery within 2 business days.

ZERO TOLERANCE POLICY:

At Kachemak Bay Animal Hospital, effective and respectful communication is essential to our veterinary care. We prioritize mutual trust between client and doctor to ensure a strong veterinary-client-patient relationship. We aim to exceed these standards and expect clients to treat our staff with the same respect. We have a zero tolerance policy regarding verbal or physical abuse of any kind directed at our staff and/or doctor(s).

TREATMENT CONSENT: By signing below, 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 Kachemak Bay Animal Hospital 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.*

Welcome!

Hospital Policies and Procedures