Client Information Form — The Oaks Veterinary Clinic

Client Information

Welcome to our Clinic

We are glad to have the opportunity to care for your pet.

To ensure your pet gets the best care we can offer, please fill out this form completely.

Client Information

Owner

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Spouse

First Name

Last Name

Phone

(###)

###

####

Are you interested in receving information for the following:

Care Credit

Pet Insurance

Emergency Contact (other than above)

First Name

Last Name

Phone

(###)

###

####

How did you hear about us?

Referral Club - The Oaks Veterinary Clinic invites you to be a part of our Referral Club. A $10 credit will be applied to your account for every new client that lists you as recommending them to our clinic! Who may we thank for referring you?

IMPORTANT CLINIC INFORMATION - Our clinic hours are 8:00 am - 6:00 pm Monday - Friday and 8:00 am - 12:30 pm on Saturday. We are closed between the hours of 6:00pm and 7:30 am, Monday through Saturday morning, and between 12:00pm Saturday to 7:30 am Monday and between 6:00 pm before a scheduled holiday to 7:30 am the following business day. There is no one on staff continuously in the facility during these hours. We are available by phone from 7:30 am - 5:30 pm Monday - Friday, and 7:30 am -12:00pm Saturday. Please be advised we are closed after hours and that we are not a 24 hour clinic. If there is an emergency after hours you are advised to take your pet to an emergency clinic. If you pet stays overnight there will not be a staff member in the clinic continuously after hours.

Refills will not be filled for any patient who has not been seen in over one year

Payment is due when services are rendered by check, cash, Visa, Mastercard, Discover, American Express or Care Credit. A $35.00 fee is charged for returned checks. Finance charges are applied to unpaid balances over 30 days at the rate of two percent per month which is an annual percentage rate of twenty-four percent; with the addition of any or all Collection agency, Court Cost, Attorney Fees necessary to collect the full amount due to The Oaks Veterinary Clinic without any relief whatever from valuation or appraisement laws (These fees are approximately 30-50% of the account)

Electronic Signature - A COPY OF THIS DOCUMENT WILL SERVE AS THE ORIGINAL. Your e-signature serves as the legal equivalent of your handwritten signature.

Date

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