Boarding and Daycare Agreement Form | Mountain View Animal Hospital & Holistic Pet Care

Name:*

First Last

Employer:*

Occupation:*

Spouse's Name:

First Last

Spouse's Employer:

Occupation:

Mailing Address:*

City:*

State:*

Zip:*

*PLEASE SELECT WHICH NUMBER YOU WOULD LIKE AS YOUR PRIMARY PHONE NUMBER*

Home Phone
Cell Phone
Work Phone
Spouse Phone

Cell Phone:*

Home Phone:

Work Phone:

Spouse Phone:

^**We respect your privacy and will never share your information without your consent. We use email as a form of primary communication to relay important information or changes about our hospital, education and share our upcoming promotions. In addition, you may receive your pets healthcare reminders and have the ability to confirm upcoming scheduled appointments.^**

Email:*

Is there anyone else you would like to add to the account that could have access to your pets healthcare information (family member, pet sitter, etc)?

Name:

First Last

Contact Number:

Relationship to you or your pet:

Additional Information

Do you plan to make this practice your primary veterinarian?*

Yes
No

Name of Your Last Visited Animal Hospital:*

How did you hear about us?*

If Existing Client/Employee Please List Their Name:

First Last

It is important to us as an Integrative Animal Hospital to understand how you would like us to discuss healthcare options for your pet. How much of a Holistic (natural) approach do you prefer in your pet's health? (1 being the lowest; 5 being the highest):*

Please enter a number from 1 to 5.

Treatment Consent

I, the owner of the patient(s), hereby authorize the veterinarians and staff of Mountain View Animal Hospital & Holistic Pet Care to examine, treat, and prescribe necessary medication for the above listed pet. This includes, but is not limited to, procedures therapeutically and/or diagnostically. I understand that no guarantee of successful treatment is made. I further understand that this facility has a doctor on staff between 7:30am to 5:30pm only, therefore, there is no continuous presence of doctors after regular business hours. I certify that all the information above is correct, that I am the rightful owner or authorized agent of this pet(s) and that I am at least 18 years of age. Mountain View Animal Hospital & Holistic Pet Care does not operate as an emergency hospital and although we will always try to be available, I understand I may be referred to an emergency hospital even during open hours if we feel it is best for my pet(s).

I understand by Nevada pharmaceutical law, all prescriptions including herbals that leave the hospital are non-refundable, even if my pet(s) has a reaction.

Payment Policy

Please note: All fees incurred at Mountain View Animal Hospital & Holistic Pet Care are required to be paid upon time of service. We do not accept payment plans or delayed billing. Any unpaid balance left unpaid are subject to accrued 1.5% interest after 30 days, and balances left unpaid for more than 90 days will be sent to collections in addition to a 40% collection fee. There is a $35 charge for each returned check, and we do not accept any postdated checks.

We accept Visa, Mastercard, American Express, CareCredit & for established clients (been here at least 2 times) we also accept checks.

Cancellation Policy

We request that any cancellations be made at least 24 hours prior to the start of your pet's medical appointment, grooming appointment or boarding/daycare reservation. If you cancel without ample notice or do not show up to your appointment or boarding/daycare reservation you may be required to pay a cancellation fee. This fee is non-refundable and cannot be applied toward any other services.

I have read, understand and accept all the information above.

Signature*

Date*

Mountain View Animal Hospital and Holistic Pet Care

6474 Bonde Lane Reno, NV 89511

775-853-6900 (phone); 775-853-6966 (fax)

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