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Willis Vet - New Client Form

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    (Mark ALL that apply)
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    On occasion, we like to use our patient's photos/cases for promotional purposes, contests, medical information and social media. Do we have your permission to post your pet(s) photo's and/or story and medical information for these purposes? No client information will be released.
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    ALL ANIMALS COMING INTO THE HOSPITAL MUST HAVE A CURRENT RABIES VACCINE. IF PROOF IS NOT PROVIDED A THE TIME OF VISIT, A RABIES VACCINE WILL BE GIVEN AT YOUR EXPENSE.

    TO HELP PREVENT THE SPREAD OF INFECTIOUS DISEASE, ALL HOSPITALIZED, BOARDING, AND DROP OFF ANIMALS MUST BE CURRENT ON ALL VACCINATIONS AND FLEA FREE.

    BY SIGNING THIS DOCUMENT, I ATTEST THAT I HAVE READ AND AGREE TO THE AFOREMENTIONED CONDITIONS.

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    By signing this form, I give Stone Ridge Veterinary Medical Center permission to save my debit/credit card for future transactions. Future transactions include but are not limited to: invoices not paid for at the time of service, last-minute appointment cancellations or appointment no-shows.
    (1). An 'intent to charge' text will be sent 24 hours prior to the card being charged.

    (1) Last minute cancellations and no shows take away from our limited appointment times that would have allowed our doctors to see other patients. Should you need to cancel an appointment, we ask that you do so before 5 p.m. the day prior to your scheduled visit. If not, you may be charged for the missed appointment that would be congruent to $61.28 - $76.28, based on the type of appointment missed.

        Signature

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    • Dog
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    • Spayed
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