Veterinary Client Enrollment Form Logo
  • Client Registration

    Thank you for considering Queen City Animal Hospital for your pet's needs! We are super excited to see you and your pet(s). In order to provide you with the best possible service, please fill out our new client/patient registration form in its entirety. (We know, it feels like a lot, but this relationship is important to us!)
  • *Please note: We will reach out to you as soon as we are able. If you'd like an appointment as soon as possible, please reach out to our team directly at 704.703.1414 or schedule online at www.queencityanimalhospital.com

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  • This form supports telling us about 4 pets in your home. If you have more than 4 pets, please let our office know and we will happily collect information to add them to your account!

  • Client Policies and Procedures

    We want you to be aware of and understand the following policies and procedures for all clients.
  • We get it, finding time in your overbooked schedule for a vet visit is hard. In order to ensure that we can provide appropriate amounts of time for all of our patients, we have to stress the importance of showing up for scheduled appointments.  In lieu of requiring deposits, Queen City Animal Hospital requires a credit card to be held on file for all appointments. This card is securely stored through Stripe or World Pay, merchant services processors, and is only charged for approved transactions or in the event of a breach of our cancellation policy found below. Really, we just ask that you give us enough time to cancel or reschedule so that we can help another patient in need.

    Cancellation and Rescheduling Policies

    - For scheduled appointments with the doctor: 

    In order to avoid penalty, you must reschedule or cancel with at least 24 hour advance notice prior to the day and time of the appointment. This can be accomplished via phone call to our hospital, voicemail, email, or via text message. If you contact us to cancel or reschedule at more than 24 hours prior to the appointment, then you will not be charged for the canceled appointment. However, If you fail to show for your pet's appointment, cancel or reschedule within the 24 hours, your card on file will be charged for the amount of the doctor's exam associated with your visit. This ranges between $55-$110 as of this date, and is dependent upon the type of appointment scheduled for your pet.

     
    - For scheduled surgical or dental procedures: 

    In order to avoid penalty, you must reschedule or cancel with at least 72 hour advance notice prior to the 8:30am drop off time on the day of the scheduled procedure. This can be accomplished via phone call to our hospital, voicemail, email, or via text message. If you contact us to cancel or reschedule at more than 72 hours prior to the procedure, then you will not be charged for the canceled procedure. However, If you fail to show for your pet's procedure, cancel, or reschedule within the 72 hours, your card on file will be charged $150 for most procedures, or $50 if your spay/neuter was scheduled as part of our puppy/kitten package. 

    All charges initiated will appear as Queen City Animal Hospital. 920 Belmont Ave, Charlotte, NC 28205, USA.

    This policy will remain in effect for all clients of Queen City Animal Hospital until otherwise noted. Any changes to this policy will be emailed to you at the email address listed above. 

    By entering your credit card information, you agree to the above terms for stored credit cards and the cancellation/rescheduling policy and authorize Queen City Animal Hospital to process agreed upon transactions, as well as Merchant Initiated Transactions in the event of a breach of the policy above. 

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    Payment Details
  • FINANCIAL POLICY:

    We strive to make paying for your pet's care as easy as possible. Our office accepts Visa, Mastercard, Discover, American Express, and Venmo. We also accept cash.

    In addition, we also offer several 3rd party financing options for our clients via Care Credit and Scratchpay. We accept a variety of Care Credit plans based on the total transaction amount for your pet. Care Credit requires that payment only be made for services as they are rendered, we cannot charge services to your account in advance. Additionally, use of Care Credit requires that the card be present every time and that two forms of identification are verified. We appreciate your understanding of our desire to protect your account/identity.

    As financing options are offered, we cannot offer additional in-house payment plans for our services. Clients needing additional financial support are encouraged to apply for Care Credit with a co-signer.

    Full payment is due at the time of service. Our team is happy to provide any client with a written treatment plan prior to services being rendered. Client will be responsible for a 1.5% monthly finance charge on accounts over 30 days and any collection and/or legal fees on accounts over 90 days. Your signature below indicates your agreement with these policies.

  • Respectful Environment Policy:

    R E S P E C T, find out what it means to us.

    At Queen City Animal Hospital, we are commited to providing a safe, respectful, and inclusive environment for our clients and our employees. As such, we require that all communication between our clients and our staff remain professional at all times. We must make it unequivocally clear that any form of abuse, mistreatment, harrassment, or discrimination directed towards our staff by clients will not be tolerated under any circumstances (nor do we tolerate any of the above behavior from our employees). We take reports of staff abuse by clients seriously and will investigate all incidents promptly. Appropriate actions, which may include restricting client access to our services or taking legal action, will be taken against those responsible for such behavior. 

    So, let's not get to that point. Please just keep an open line of communication with us, so that we can address any issues in an appropriate and healthy manner. Disagreements may be few and far between at our hospital, but we know things can happen. We want to ensure that our relationship remains professional at all times!

  • Fear-Free Philosophy

    We don't want your pet to hate trips to the vet! At Queen City Animal Hospital, we wholeheartedly embrace and are deeply committed to the Fear-Free Philosophy in veterinary medicine. We recognize the importance of providing compassionate and fear-free care to our animal patients, ensuring their physical and emotional well-being throughout their visit to our hospital. Our commitment to this philosophy is reflected in the following principles:

    1. Reducing Fear and Anxiety:

    We understand that fear and anxiety can significantly impact an animal's health and well-being. We are dedicated to minimizing stress and fear during all aspects of a pet's visit, from the waiting room to the examination and procedures.

    2. Compassion and Empathy:

    Our staff is trained to approach every patient with compassion, empathy, and patience. We prioritize creating a safe and comfortable environment where animals feel respected and cared for.

    3. Gentle Handling:

    We use gentle and low-stress handling techniques to ensure the physical and emotional comfort of our patients. Our team is trained to recognize and respond to signs of stress and fear in animals and adjust their approach accordingly.

    4. Communication:

    We believe in open and transparent communication with pet owners. We educate them about the Fear-Free Philosophy and involve them in the care process. We offer guidance on techniques to reduce fear and anxiety at home and during veterinary visits.

    5. Ongoing Training:

    Our staff participates in continuous training and education to stay updated on Fear-Free techniques and best practices. We prioritize the well-being of our team members, recognizing that their comfort and confidence contribute to a fear-free environment.

    6. Creating a Fear-Free Environment:

    We have designed our hospital to minimize fear triggers and provide a calming atmosphere for pets and their people. We use pheromone diffusers, calming music, comfy rugs and chairs, high reward treats, and other techniques to create a positive environment. We offer refreshments (including beer, wine, sparkling water, juice boxes, and coffee) for our pet owners because you deserve a fear free experience too.


    7. Respect for Individual Needs:

    We understand that every pet is unique and may have specific needs and fears. We tailor our approach to each patient, using Fear-Free methods to accommodate their individual requirements.


    8. Pain Management:

    We prioritize pain management and utilize fear-free techniques for administering medication and treatments. Our goal is to ensure that all animals are as comfortable as possible during their recovery.


    9. Collaboration and Advocacy:

    We actively collaborate with other professionals in the veterinary field to promote the Fear-Free Philosophy. We advocate for the well-being of animals and the importance of fear-free practices within the veterinary community.


    By adhering to the Fear-Free Philosophy, we aim to provide the highest standard of care to our patients while fostering trust and partnership with our clients. This means that our visits may be a little different than what you've experienced in the past. We work with your pet to determine the best course of action when providing the care they need. If they are experiencing a high amount of fear, stress, or anxiety at a visit, we may discontinue services that day and discuss options with you to help create a better experience going forward. It's all about making sure that your pet receives the care they need without the distress that may have come from that care in the past.

    We are proud of our commitment to reducing fear, anxiety, and stress in veterinary medicine and are dedicated to improving the lives of the animals we serve while strenthening their bond with you!

  • and finally, TREATMENT CONSENT:

    By signing this document, I declare I am the lawful owner of all listed pets and all information is true and correct to the best of my knowledge. I hereby authorize the veterinarian(s) of Queen City Animal Hospital to examine, prescribe, and administer treatments for my pet(s) to the best of their abilities. I assume responsibility for all charges incurred in the care of this animal(s). I acknowledge that medical information will not be released to anyone not indicated on this form without my express verbal and/or written permission with the exception of another veterinary facility. 

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