From time to time, your pet may need additional care from other pet care providers such as:
We would appreciate your permission to share your pet’s medical records when requested by these other parties so we can help streamline the process and prevent delays. Boarders and groomers often need current vaccination and parasite check records to allow admittance; pet health insurance companies typically need to see records to process claims; specialty and emergency practices have an easier time of creating treatment plans when they have the whole history.
To prevent the delay of services, we request your permission to share medical records when requested for your pet. Please indicate your choice below
From time to time, My Neighborhood Vet wants to feature your pet(s) on social media (when appropriate)! We ask your consent to take and post photos, and write fun details about your pet(s) to other pet lovers on our website and social media. Posting of these photos is for fun and to engage our clients and community. We encourage you to follow us, share any of our posts, comment on them, and tag yourself whenever possible!
I grant permission to My Neighborhood Vet, its employees and authorized representatives to take photographs and/or video of me and/or my pet(s), to copyright, use and publish the same in print and/ or electronically. My Neighborhood Vet may also use and publish my pet’s story, including relevant medical history. I understand and agree that any photograph using my or my pet’s likeness will become property of My Neighborhood Vet and will not be returned.
I agree that My Neighborhood Vet may use such photographs, videos, or stories including me and/or my pet(s) with or without our names and for any lawful purpose, including for example such purposes as social media, publicity, advertising, and other web content.
I hereby authorize My Neighborhood Vet to edit, alter, copy, exhibit, publish, or distribute this photo for the purposes of publicizing My Neighborhood Vet’s programs or for any other related, lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my or my pet’s likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph.
I acknowledge that since my participation with My Neighborhood Vet is voluntary, I will receive no financial compensation.
Payment is due in full at the time that services are performed. We do not bill for services. Patient care is by verbal and written consent. We accept Visa, Mastercard, American Express, and Discover payments. We do not accept cash at this time. Checks will not be accepted. We do not extend credit. [All open invoices are sent to collections after 45 days./ If the account goes delinquent, I understand that a minimum of 3.00% interest will be charged monthly until the account is paid in full. I further agree that if the account is transferred to collection, I will be responsible for all cost necessary to collect this balance including collection fees, attorney fee, court cost, and filing fee. If a check is returned for non-sufficient funds, a minimum $25.00 fee will be added to the amount owed.]
We encourage the use of Pet Health Insurance, and will prepare and send claim forms promptly in order to expedite your reimbursement.
We also accept Care Credit. We can assist you in your application to Care Credit at the reception desk. Any information that we collect is private and for our use only.
By admitting my pet for diagnostics, treatment, or surgery, I authorize the veterinarians of My Neighborhood Vet and their support staff to administer such treatment and/or perform such diagnostic or surgical procedures deemed necessary. It is understood that an estimate of charges will be given for services when requested. No guarantee or assistance can be made to the results that may be obtained. Further, I realize that these charges may exceed a given estimate if complications arise. I understand that I will be contacted prior to treatment, if possible, should complications occur.
Late Arrival Policy
We strongly believe in providing our clients and their pets the full attention they deserve. As such, if you are late by the amount of time that equals half of your appointment slot, we will have to respectfully ask you to reschedule.
We understand that life sometimes gets in the way and you can’t make your scheduled appointment at My Neghborhood Vet. To help us out, it’s important for clients to give us at least 24 hours notice prior to cancelling or rescheduling an appointment. Doing so ensures that we can make the time available for another pet in need. On the 3rd cancellation or rescheduling of any appointment within 24 hours of an appointment, I understand that a non-refundable deposit of $75 per pet, per appointment will be charged.
By signing my name below, I certify that I have read and consent to the above information. Any questions concerning these policies have been discussed. My signature also certifies my understanding of and agreement with the above policies.
Please send a picture or scanned copy of any records ahead of your appointment to email@example.com Sending them ahead of time will help the doctor have a chance to review them prior to your appointment.
For additional pet registration, please submit this form and then click on the link on the next page to register your additional pet.