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Client Agreement & Information

Client Agreement & Information

Please complete this form prior to your home visit.
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    Please Select
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    • Alabama
    • Alaska
    • Arizona
    • Arkansas
    • California
    • Colorado
    • Connecticut
    • Delaware
    • District of Columbia
    • Florida
    • Georgia
    • Hawaii
    • Idaho
    • Illinois
    • Indiana
    • Iowa
    • Kansas
    • Kentucky
    • Louisiana
    • Maine
    • Maryland
    • Massachusetts
    • Michigan
    • Minnesota
    • Mississippi
    • Missouri
    • Montana
    • Nebraska
    • Nevada
    • New Hampshire
    • New Jersey
    • New Mexico
    • New York
    • North Carolina
    • North Dakota
    • Ohio
    • Oklahoma
    • Oregon
    • Pennsylvania
    • Rhode Island
    • South Carolina
    • South Dakota
    • Tennessee
    • Texas
    • Utah
    • Vermont
    • Virginia
    • Washington
    • West Virginia
    • Wisconsin
    • Wyoming
    Please Select
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    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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    Typically, this may be 6 or fewer e-mails per year.
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    Photo/Video/Social Media Authorization

    With your permission, we occasionally post images and videos of our patients, patients with our staff and patients with their people on our social media sites and/or our website. We don't mind at all, if you would prefer not to have any photos or videos shared, but we would like a photo for our records.

    Please click "Next" below and choose what level of permission you give us to use for social media and our website.

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    One-Hour Arrival Window Scheduling - Please read and click "Next"

    We schedule our appointments in 1-hour arrival windows to account for unexpected traffic, weather, extended appointments with sick patients, or other unforeseen circumstances.

    You will always receive the doctor's full attention and time when they arrive.

    We will contact you if we believe that we may arrive outside of our appointment window.

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    Urgent Appointment Scheduling/Rescheduling - Please read and click "Next"

    Occasionally, when our appointments are full, another very sick patient may need help.

    If your scheduled appointment is a wellness appointment or not urgent, we may want to ask you if you would be willing to move your appointment to another day or time.

    We would only contact you if your scheduled visit was for a wellness visit (annual exam) or other non-urgent appointment.

    We are hopeful that by being willing to move your non-urgent appointment, others will do the same for you if your pet becomes sick and needs to be fit into our schedule.

    It is possible that all the pets on our schedule for a particular day are sick and unable to move appointments, but we will always check our schedule and try to fit in visits when urgent.

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    Cancellation of Appointments - please read completely and then click "Next"

    We visit a very limited number of patients in order to provide personal, extended appointment times. Appointment cancellations are difficult to fill at the last moment, and each house call accounts for about 20% of our business each day.

    We understand that urgent life matters can arise, but we would appreciate if you could keep your appointment with us unless there is an emergency.

    If your cancellation notice is 30 minutes or less prior to your appointment window, you will be charged the house call fee portion of our normal visit ($95-$155).

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    A "NO" answer will require the cancellation of your appointment.
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    Payment - please read completely and then click "Next"

    Payment for all services is required at the time of service and prior to any supplies that may be mailed. Pre-payment for goods and some services may be made online or on the telephone.

    Medications ordered through our online store or from our in-house pharmacy must be paid for in advance prior to shipment. In-house pharmacy orders can also be picked up in person and paid for at the office.

    All sales of medication are final. By Oregon law, we cannot accept returns of medications that have been dispensed (unopened or opened).

    We can provide you with options if you wish to donate any unused medication to rescue/shelter organizations or families/pets in need.

    Checks are our preferred form of payment. We also accept VISA, MasterCard, Discover, and American Express.

    We're sorry, but we do not accept Care Credit.

    We can securely store payment information (credit cards or bank account for e-checks) in our payment system. If you would like to set up an account for any payments to be charged to, please call our office at 503-281-1631.

    Any balances that may be due under special circumstances must be made within 14 days of the invoice date.

    Past due accounts will be assessed a minimum balance of $2.00 or 2.0% financing fee (whichever is higher) for all accounts that are past due 14 days or more.

    Any account more than 90 days past due will be referred to a collections service.

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    A "NO" answer will require the cancellation of your appointment.
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    Safe Appointment Policy

    All Pets:

    All pets, regardless of their breed, temperament, stress, anxiety or aggressiveness deserve a periodic exam or treatment for illness/injury.

    We strive to provide the lowest stress veterinary visit and examination possible, using the least amount of restraint (none if possible).

    Most pets experience much less stress at home and almost all of our visits are very pleasant, comfortable and low stress.

    Clients are welcome to be near and observe the examination, but to ensure our staff's safety, the safety of your pet and yourself, after the examination begins, please do not attempt to hold, restrain or put your hands near the face or mouth of your pet.

    Safe Appointments - Aggressive, Fear Aggression, Fractious Pets

    Safety is our first priority. When we visit a highly stressed or aggressive/fractious pet for the first time, it may take more than a single visit to be able to achieve a safe exam.

    If a pet is too aggressive or fractious to safely examine, and our staff cannot safely sedate the pet, a second visit will be required on another date. Before the second visit, your pet may be prescribed a sedating medication to take prior to the second appointment.

    Clients are required to inform At Home Veterinary Staff if their pet has ANY history of aggression toward people. This includes growling, biting, scratching, or attacking family, friends, veterinary staff, etc.

    Once informed of an aggressive/fractious history, we will provide you with information about how we approach these visits in a way that is in the best interest of the pet and the people in proximity.

    Dogs may be required to wear a muzzle that is placed by the client prior to the doctor's arrival. If the owner cannot safely place a muzzle on their dog, our team will not be able to visit. All dogs do not need to be muzzled, and we prefer to work without a muzzle when it is safe to do so.

    Home visits with aggressive pets may be terminated at the discretion of the attending veterinarian if it is not safe for the patient, the client, or veterinary staff to continue the exam.

    House call fees are charged for all visits, regardless if an exam is able to be completed on the first visit. Consultation fees may be charged during the first visit to prepare a plan for following visits and review medication instructions.

    Visits with stressed, anxious or aggressive pets generally take longer than our standard 40-minute exam and may incur additional time charges.

    Guardians with aggressive pets that cannot be safely examined may be referred to a Veterinary Behaviorist before any future appointment would be considered.

    If a pet owner or another person living or visiting the home (other than At Home Veterinary Services staff) is bitten by a pet, we are required by law to report it to the county in which the bite occurred.

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    Selecting no will require the cancellation of your appointment.
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