Ridgeline Veterinary Clinic

Client's Information

Client's Name (Owner)(Required)

First Last

Client's DOB(Required)

*Dispense of control substances

Home Phone(Required)

Work Phone

Cell Phone

Primary Email(Required)

Please be advised an email address will be required for clients to receive any upcoming service reminders for your pets.

Primary Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Spouse

First Last

Spouse Phone

Patient Information

Pet Name(Required)

Breed(Required)

Color(Required)

Pet's DOB/Age(Required)

Microchip ID#

Sex

Male

Female

Spayed

Neutered

Species

Feline

Canine

Vaccine History

Rabies (canine/feline) Date

DH2PP (canine) Date

Bordetella (canine) Date

Rattlesnake (canine) Date

Influenza (canine) Date

Leptospirosis (canine) Date

Feline Leukemia (feline) Date

FVRCP (feline) Date

Fecal Test (canine/feline) Date

Heartworm Test (canine/feline) Date

Name(Required)

First Last

Date(Required)

POLICY ON CANCELLATIONS OF APPOINTMENTS/NO-SHOW

WE WOULD LIKE TO INFORM YOU OF A POLICY ON CANCELLATION OF APPOINTMENT/NO -SHOW. EFFECTIVE JULY 1ST, 2021

This policy has been established to provide the highest level of veterinary care to all our patients.

By providing us notice of a cancellation, we may be able to accommodate other patients with your appointment slot. When you do not show up for a scheduled appointment, it creates an unused appointment slot that could have been used for another patient.

It is very important that you call within 24 hours in advance to cancel your appointment.

NEW CLIENTS:

• New client will be charged $25.00 fee if failure to show for their initial visit. This fee must be paid prior to rescheduling your next appointment.

• If new client fails to show or cancels/reschedules an appointment with no 24-hour notice. There will be a second charged a $50.00 fee and will not be rescheduled.

EXISTING CLIENTS:

• Established client who fails to show or cancels/reschedules an appointment and has not contacted our office with at least 24 hours’ notice will be considered a No Show. They then will be charged a $25.00 fee. This fee must be paid prior to your next appointment. If for any reason you need to cancel an appointment, please notify our office as a soon as possible.

• Established client who fails to show or cancels/reschedules an appointment with no 24-hour notice. There will be a second charged a $50.00 fee.

• If a third No Show or cancellation/reschedule with no 24-hour notice should occur the patient may be dismissed from Ridgeline Veterinary Clinic.

• The fee is charged to the client and is due at the time of the next rescheduling of the next office visit.

• As a courtesy, when time allows, we make reminder calls. If you do not receive a reminder, call the above Policy will remain in effect.

WE UNDERSTAND THERE MAY BE TIMES WHEN AN UNFORESEEN EMERGENCY OCCURS AND YOU MAY NOT BE ABLE TO KEEP YOUR SCHEDULED APPOINTMENT. YOU MAY CONTACT RIDGELINE VETERINARY CLINIC, MONDAY THROUGH FRIDAY AT THE PHONE NUMBER OR EMAIL BELOW. SHOULD IT BE AFTER REGULAR BUSINESS HOURS MONDAY THROUGH FRIDAY OR A WEEKEND, YOU MAY LEAVE A MESSAGE OR EMAIL.

Client Name(Required)

First Last

Date(Required)