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E-Mail Address (required) :
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Employer
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Ok to call work? (required)
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How do you prefer to be contacted? (required)
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How did you first learn of our hospital?
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Referred by:
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Other source:
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Clearview Animal Hospital Financial Policy Financial Responsibility: I accept full and total financial responsibility for any and all services explicitly requested by myself or my designated agent, as well as services implied under the terms of consents that I or my authorized agent have signed.These services include but are not limited to services provided by Clearview Animal Hospital, its staff, and subcontractors hired by the same on behalf of my animal/pet. |
Payment Policy: Payment for all services rendered are due either at the time of dismissal, when services are performed, or upon request and demand at any time. Clearview Animal Hospital does not allow for billing, partial payment, or delayed payment. Clearview Animal Hospital reserves the right to require partial or full deposits before services are rendered. |
Price Matching: Our prices are based on the costs at our hospital. Larger retailers are often able to negotiate lower prices, and online retailers have a lower overhead due to not maintaining a storefront. Clearview Animal Hospital is not able to match lower prices found elsewhere, but we are always happy to write you a prescription for you to fill at the pharmacy of your choice. |
Forms of Payment Accepted: For your convenience, we accept MasterCard, Visa, Discover, American Express, CareCredit, and cash subject to the conditions noted below. |
Check Acceptance: Clearview Animal Hospital does not accept personal checks. |
Credit Cards and Debit Cards: Clearview Animal Hospital is happy to take these forms of payment, but they must be processed immediately and the owner of the card must be present. |
CareCredit: Clearview Animal Hospital offers CareCredit as a means to pay veterinary bills; this can be lifesaving in emergencies. CareCredit is a healthcare credit card for treatments and procedures for your entire family, including your pets. Please ask for more information. |
Pet Insurance: We also encourage you to consider whether pet insurance is a good choice for your family. With pet insurance, you are responsible for paying the bill at the time of service and your insurance company would reimburse you according to their agreement at a later time. |
Refunds: All sales for services rendered are final and not refundable. Sales for dispensed pharmaceuticals are final and not refundable. Sales of prescription veterinary diets are guaranteed by the manufacturer and are always refundable. Sales of non-prescription products may be final and non-refundable, partially refundable, or fully refundable at the discretion of Clearview Animal Hospital. |
Fees are due at the time services are rendered.
You assume full financial responsibility for all charges incurred by your pet(s). |
Please confirm that you have read and understand all above statements (required)
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Date (required)
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We will gladly discuss and/or prepare a written estimate of charges for recommended procedures and services.
We accept cash, debit cards, VISA, MasterCard, Discover Card, American Express and Care Credit. |
Pet Name (required)
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Species (required)
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Breed (required)
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(required)
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Date of birth or approximate age? (required)
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Color & Markings (required)
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Microchipped? (required)
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Microchip Number (if applicable)
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Vaccination history (please check all that apply) (required) Rabies Canine Distemper-Parvo Combination (DA2PP) Leptospira Bordetella Canine Influenza Feline Distemper Combination (FVRCP) Feline Leukemia Other
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Previous Veterinary Provider (NA if Not Applicable) (required)
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Previous Veterinary Phone Number (for records) (required)
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Previous Veterinary Provider if more than one (NA if Not Applicable)
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Previous Veterinary Phone Number if more than one (for records)
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Current Diet (required)
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Current Medications (NA if Not Applicable) (required)
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Illness/Accidents/Injuries
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Surgery/Dentistry
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Pet Photo Consent Agreement (choose ONE of the following) (required)
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Please confirm that you have read and understand all above statements (required)
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Date (required)
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