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New Client Form

Please fill out the form below as accurately as possible!

Today's Date *

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Email *

Pet's Name *

Age/Date of Birth *

Species (dog, cat, etc.) *

Breed *

Color *

Sex *

Male
Neutered Male
Female
Spayed Female

AUTHORIZATION

I am the owner of the above animal or am responsible for it, am 18 years of age or older, and have the authority to execute this consent and hereby authorize Veterinary Hospital at the Lake after consultation with me to administer treatments and perform procedures that are necessary for the well-being and care of the Pet. I understand that there are no guarantees associated with any treatments and procedures. I assume personal financial responsibility and agree to pay for all charges and expenses invoiced at time of service. I agree to pay a recurring 1.5% per month interest on any amounts unpaid after 30 days, a $40 service charge for each NSF check, and any and all costs and expenses, including legal fees, for collection of any and all unpaid amounts. Payment is required at time of service. For your convenience, we accept Visa, MasterCard. Discover, American Express, Care Credit, Cash or Check. We also accept PayPal payments via our website @ www.vetspecialtiesatthelake.com. If I neglect to pick up the pet within five days of written notice, sent to the above address, my pet will be considered abandoned. In cases of abandonment, Veterinary Hospital at the Lake will have authorization to take care of the pet as seen fit. Abandonment does not release me from my obligation to pay for all charges involved. *

I have read and accept the policy.

RECORDS RELEASE

I hereby give Veterinary Hospital at the Lake its representatives and employees permission to send my pet's records as needed to other clinics and facilities. *

I have read and accept the policy.

MEDIA RELEASE

I hereby give Veterinary Hospital at the Lake its representatives and employees the right to take photographs and videos of me and/or my pet, and to copyright, use and publish the same in print and/or electronically. I agree that Veterinary Hospital at the Lake may use such photographs/videos of me and/or my pet with or without my pet's name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, social media and Web content. I understand my pet's image may be edited, copied, exhibited, published or distributed and waive any right to royalties or other compensation arising or related to the use of my pet's image or recording. *

I have read and accept the policy.

CANCELLATION, NO SHOW AND LATE FEE POLICIES

Each time a patient misses an appointment without providing proper notice, another patient is prevented from receiving care. Therefore, Veterinary Hospital at the Lake has the following policies:

NO-SHOW = If an appointment is missed without 24 hours notice:
- There will be a non-refundable no-show fee of $75 for surgical appointments
- 1st No-Show- we will call and inform you that your appointment was missed and explain our no-show policy again.
- 2nd No-Show- We call you to inform you that your appointment was missed, we will work with you to re-schedule your appointment and we will require that you pre-pay the exam fee for that next appointment at time of rescheduling.
- 3rd No-Show- We reserve the right to apply your pre-paid exam fee as a no-show fee, we will call to inform you that your appointment was missed for a third time and we will proceed with termination from the practice.
LATE ARRIVAL = Arriving 5 Minutes Past Your Scheduled Appointment Time:
- If you arrive 5 minutes past your scheduled appointment time, a $15 delayed fee will be assessed as this puts our staff and the rest of our appointments behind.
- After 10 minutes, we will mark the appointment as a no-show and proceed with our no-show policy
- If you show up for your appointment after 10 minutes, we will discuss with our technical staff if we are able to still work you in as we will then be behind in our schedule. If we can work you in, there will be a $30 work-in fee assessed.
SPECIALIST APPOINTMENT
- If your pet is scheduled for a procedure with a specialist (outside specialist we are bringing in), we require a $300 deposit due at time of scheduling procedure.
- We require that you give us 48 hours notice if you are needing to cancel your specialist appointment.
- If you give less than 48 hours notice for cancellation, your $300 deposit will be retained for specialist cancellation fee.
- Otherwise, your $300 deposit will be applied to your pet's specialist procedure.

I have read and accept the policy.

You can schedule/change an appointment from our App, your Pet Portal or call to speak with a Client Care Representative at 828-478-3500.

Thank you for your understanding and cooperation as we strive to best serve the needs of all of our patients.

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Where EVERYONE is special

New Client Form

New Client Form

AUTHORIZATION

RECORDS RELEASE

MEDIA RELEASE

CANCELLATION, NO SHOW AND LATE FEE POLICIES

Locations We Serve

For Theriogenology Services

For General Medicine and Surgery

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