Urban Veterinary Assocites 

35 N Cass Ave Westmont, IL 60559

P: 630-541-8088

E: hospital@urbanpetvet.net

Urban Veterinary Associates will never rent or sell your personal contact information to any outside party. The practice will only use email addresses or text messages for the following:

• Appointment reminders
• Exam/Wellness Service/medication reminders
• Messages from the medical team pertaining to your pet’s health
• Promotional offers, coupons, or news/announcements. (e-mail only)
• We will limit promotional e-mails to only 2-3 per 6-week period.

I confirm that I am 18 years old (or older) and I am the owner (or authorized agent of the owner) for the pet(s) listed above. I understand that, except in dire emergencies, all treatments and procedures will be discussed with me prior to implementations and a written medical plan will be provided. I agree to assume responsibility for all charges incurred in the care of my pet(s), as well as reasonable attorney fees, court costs, and interest if the balance is sent to collections.

I understand that full payment is due the time services are rendered, and that Urban Veterinary Associates does not bill for services or provide payment plans for treatment. Payments must be made in the form of Cash, Visa, Mastercard, Discover, Amex, CareCredit, Scratchpay and the All Pet Card. 

Urban Veterinary Associates will accept checks only from established clients that have been with our practice for greater than 1 year without an outstanding balance. 

At least one picture identification is required if you pay by credit card, check, CareCredit or Scratchpay. I acknowledge that I have read, understand, and agree with the above information.

CANCELLATION POLICY
Our goal at Urban Veterinary Associates is to provide the highest quality medical care for your pet. Each appointment is dedicated to each patient to discuss concerns and recommendations. Please provide ample notice if you have to cancel or reschedule. All appointments scheduled Monday-Wednesday & Friday must be cancelled or rescheduled 24 hours prior to the scheduled appointment time. All surgical procedures, Saturday, and drop-off appointments must be cancelled or rescheduled 48 hours prior to scheduled appointment time. This time will be reallocated to someone who is in
urgent need of treatment. Failure to be present at the time of a scheduled appointment or provide fewer than required notice of cancellation will be recorded in the patient’s chart as a "No show".

• All “No-shows” for appointments will incur a non-refundable cancellation fee per patient, due immediately
• All “No-Shows” for anesthetic procedures will incur non-refundable fee of $100 per hour reserved.

Late Arrival Policy:
We make every effort to be on time for all our appointments. Unfortunately, when even one patient arrives late, it can throw off the entire schedule for that day. In addition, rushing or “squeezing in” an appointment shortchanges the patients and contributes to decreased quality of care. If you are more than 10 minutes late to your appointment, a late fee will be applied to your account. If you arrive more than 15 minutes late, your appointment will be rescheduled and a cancellation fee will be applied to your account. We apologize for any inconvenience this might cause.

For all surgery patients, patients MUST be admitted by 9 am the day of the procedure. If a patient arrives after 9 am for a surgery procedure, the procedure will need to be rescheduled and a cancellation fee of $100/hour reserved will be applied to your account.  

FINANCIAL POLICY
Prompt payment for services and products is expected at the time of service. You will receive a treatment plan before any services are performed, which will give you a cost range of the recommended medical treatment(s) for your pet. A deposit will be required at the time of hospitalization for all inpatient treatments. Acceptable means of payment include:

• Cash:
• Checks
  • Checks will only be accepted from established clients who have been with our practice for more than 1 year without an outstanding balance
    • Proper ID will be required to process a check. This includes a driver’s license or state-issued ID.
    • Any checks returned for insufficient funds (NSF) will be assessed a fee that will be added to the
      balance of your account and due immediately. Urban Veterinary Associates will no longer except checks from a client that has had a check returned for any reason. 
• Major Credit Cards:
  • Visa
  • MasterCard
  • American Express
  • Discover
  • Care Credit
  • Scratchpay
  • AllPetCard
• In rare instances or critical emergency situations where there are no other alternative forms of payment, management may arrange and authorize a payment plan. A plan must be set in place prior to any services being rendered. This will require an agreedon deposit and a completed application to include the following:
  • Full name, address, and telephone number
  • Driver’s license and Social Security number
  • Repayment terms to be determined and agreed on at time the financial arrangement is made additional services will not be provided until the outstanding balance has been settled. Delinquent accounts will be sent to a collection agency for recovery after 30-days, which may include credit reporting, and will incur a collections fee

Prescription Policy 

At Urban Veterinary Associates, we prioritize your pet’s health and convenience. To ensure your pet’s medications are up to date and their treatment plan is properly managed, we strongly encourage you to request any necessary refills or written prescriptions during their appointment. This allows us to assess their health and make adjustments if needed. Please note, any requests for written prescriptions made outside of the examination time will incur a filing and documentation fee per script. Planning ahead helps us provide the best care for your pet while also saving you time and additional costs.

Learn more about our prescription policy here. 

I understand the policies listed above: 

• Cancellation Policy
• Late Policy 
• Financial Policy
• Prescription Policy

AI Recording Consent and Release

Our veterinary services utilize and AI scribe, a tool which records
your pet's appointments for improved clinical documentation. We need your consent to proceed with the recording.

 By signing this agreement:

1. Appointment Recording: You agree that your vet appointments may be
recorded. If you don’t want to be recorded, let us know.
2. Usage Rights: You grant us permission to share these recordings, and any
other materials you choose to provide, for the purpose of improved clinical
documentation.
3. Age Confirmation & Understanding: You affirm that you are at least eighteen (18) years old, and that you understand and accept the terms in this agreement.We are committed to providing the best care for your pet in a manner comfortable for both of you.

I hereby authorize Urban Veterinary Associates, hereafter referred to as “Company,” to publish photographs taken of my pet for use in Urban Veterinary Associates’ print, online, and video-based marketing materials, as well as other Company publications.

I hereby release and hold harmless Urban Veterinary Associates from any reasonable expectation of privacy or confidentiality associated with the images specified above.

I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type associated with the taking or publication of these photographs or participation in company marketing materials or other Company publications. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever.

I hereby release Urban Veterinary Associates, it contractors, its employees, and any third parties involved in the creation or publication of marketing materials, from liability for any claims by me or any third party in connection with my participation.