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Privacy Policy Form

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Privacy Policy Form

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Consent to Release Information We respect your right to privacy. By law, we cannot release any medical record information, except rabies vaccine status, to anyone without your verbal or written consent. For your convenience, you may wish for us to share vaccination status or other requested information under certain circumstances, such as with boarding kennels, pet sitters, adoption agencies, emergency clinics, or other veterinarians. Please indicate your preference below: *

I authorize release of any medical record information to any business or individuals upon their request.
I DO NOT authorize release of any medical record information without my verbal or written consent.
I authorize release of records only to the following agencies or individuals. (Please specify below.)

Photo/Video Consent *

I authorize the use of pictures and videos of my pet on your website or social media platforms.
I DO NOT authorize the use of pictures or videos of my pet for your website or social media platforms.

Payment is due at the time services are rendered. We have your pet's best interest at heart. It is our doctors' philosophy to recommend the same care for their patients as they would for their own pets. A consultation and physical exam are the first steps in providing care for your pet. These include history taking, examination of the pet, and answering questions related to the problem or exam findings. Sometimes further information or treatment is needed. All subsequent lab tests, procedures, medications, and vaccinations have fees in addition to the physical exam and consult. You are entitled to know what that fee is; however, some of our clients find it time-consuming and cumbersome for us to continually quote prices before moving forward with the care of your pet. Therefore, we would like to know your preference so that we may serve you better. *

Please provide an estimate of fees prior to any services.
Unless I ask, I only need prices for major procedures (surgery, dentals, hospitalization) prior to invoicing.
Provide an estimate for services if the total will exceed (list below).

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Privacy Policy Form

Privacy Policy Form

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