Practice Partnership Program (PPP) Enrollment Packet

Practice Partnership Program (PPP) Enrollment Packet
Thank you for your interest in the Veterinary Diagnostic Centers Practice Partnership Program.
Our Practice Partnership Program is designed to compensate referring veterinary practices for the time and effort invested in communicating diagnostic findings directly to pet owners while maintaining continuity of care and strengthening the veterinarian-client relationship.
Please complete the following information to enroll.
Practice Information
Practice Name
Practice Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Primary Contact
Title
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Number of Veterinarians in Practice
Program Participation Acknowledgement
All veterinarians within the practice will participate in the program.
Our veterinarians will communicate diagnostic findings directly to pet owners.
We understand that Veterinary Diagnostic Centers will provide diagnostic reports to our practice and that client communication regarding results will be handled by our veterinary team.
We understand that to receive commission payments, the online referral form must be completed and the option for Veterinary Diagnostic Centers to communicate results must not be selected.
We understand that compensation is based upon the following tiered structure:
1–5 cases per month: $50 per case

6–10 cases per month: $75 per case

11+ cases per month: $100 per case
We understand that participation may be discontinued at any time and that our practice may return to the previous referral arrangement.
Payment Method
Zelle Email
example@example.com
Business Name
Bank Name
Bank Branch
Routing Number
Account Number
Account Type
Upload Voided Check or Bank Letter

Cancelof
Authorized Signature
Date

MonthDayYear
Date
Tax Information and Final Certification
Download the Federal W-9 Form
Completed IRS Form W-9

Cancelof
By signing below, I certify that I am authorized to enroll this practice in the Veterinary Diagnostic Centers Practice Partnership Program and that the information provided is accurate and complete.
Practice Representative Name
Title
Signature
Date

MonthDayYear
Date
SUBMISSION CHECKLIST

Before submitting, please verify the following:
IRS W-9 attached
Voided check or bank letter attached
Questions? Please reach out to:

Kirsten Friedrichs, CVT

Referral Relationship Manager

Email: Kfriedrichs@vdc.vet

Phone: 630-712-0120
Should be Empty:

Practice Partnership Program (PPP) Enrollment Packet

Thank you for your interest in the Veterinary Diagnostic Centers Practice Partnership Program.

Our Practice Partnership Program is designed to compensate referring veterinary practices for the time and effort invested in communicating diagnostic findings directly to pet owners while maintaining continuity of care and strengthening the veterinarian-client relationship.

Please complete the following information to enroll.

Practice Information

Program Participation Acknowledgement

Tax Information and Final Certification

By signing below, I certify that I am authorized to enroll this practice in the Veterinary Diagnostic Centers Practice Partnership Program and that the information provided is accurate and complete.

SUBMISSION CHECKLIST