Fircrest Veterinary Hospital
Client Registration
Owner information:
Name
First Name
Last Name
Spouse/Additional authorized representative:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Main Contact Number:
*
Format: (000) 000-0000.
Alternate Contact Number:
Format: (000) 000-0000.
Email address:
*
example@example.com
How did you hear about us:
**Appointment & vaccine reminders are sent by text and/or email**
FINANCIAL POLICY:
We require payment in full on the day services are provided. As the legal owner or representative, I certify that I am 18 years of age and that I have read and fully agree to this financial policy. I assume financial responsibility for all services rendered.
PAYMENT OPTIONS:
We accept Visa, Mastercard, American Express, Discover & Care Credit, debit cards & cash. All credit card (
not debit card
) will have a surcharge of 3%. Due to the high number of returned checks, we no longer accept them as payment.
CANCELLATION/NO SHOW/LATE POLICY:
We require 24-hour notice to cancel/reschedule appointments and 48-hours for surgeries. Fees incurred if proper notice is not given or if a client is a "no-show". We reserve the right to cancel/reschedule appointments if a client arrives 5 or more minutes late. Please refer to our website for full details and fees.
MEDICAL RECORDS POLICY:
As an authorized agent, it is the policy of our hospital to obtain all previous medical records for any pet receiving care. Invoices and/or receipts are
not
considered medical records. Detailed records with doctor's notes play a vital role in taking care of your pet.
WAC 246-933-320:
Veterinary medical records and medical images are the property of the veterinarian or veterinary facility that originally ordered their preparation.
CALLS ARE RECORDED:
All calls are recorded for training & quality assurance purposes.
I have read, understand and agree to the policy information provided above.
Signature of Owner/Rep:
Date:
-
Month
-
Day
Year
Date
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