Southern Hills Animal Hospital Policies TERMS, DISCLOSURES & CLIENT CONSENT We regularly review our policies to ensure they are in line with relevant veterinary boards and pet-related laws in our area. Please take a moment to review the following terms, disclosures and consent:Client ConsentI am the owner, or representative of the owner, over the age of 18, of the animal(s) presented and have authority to execute this consent. I authorize and direct the veterinarians at Southern Hills Animal Hospital to administer authorized treatment as needed on the basis of findings during the course of evaluation: to diagnose, prescribe, and perform therapeutic procedures as their judgement may dictate to be advisable for the patient’s well-being. I understand I will be advised as to the nature of the procedures and risks involved. I understand that no warranty or guarantee will be made as to the results or cure.*(Your initials here)Payment Terms & AgreementsI UNDERSTAND THAT I ASSUME RESPONSIBILITY FOR THE BALANCE OF ALL FEES FOR SERVICES AND PRODUCTS AT TIME SERVICES ARE RENDERED OR PATIENT IS DISCHARGED. (No postdated checks or "courtesy holds" on checks will be accepted.) Accepted forms of payment are Cash, Check, Visa, MasterCard, Discover, American Express, as well as CareCredit & ScratchPay. I agree to reimburse Southern Hills Animal Hospital the fees of any collection agency, which may be based on percentage at a maximum of 30% of the debit, all cost, and expenses, including reasonable attorney’s fees, which incur in such collection efforts.*(Your initials here)Upon New Client Registration a current driver's license and a social security number are required. If I decline to provide a photocopy of my valid ID and/or SSN, Southern Hills Animal Hospital will provide an estimate and require prepayment for expected services. (In the case of an emergency or if your pet's illness isn't clear, we will require a deposit of $300.00 prior to treatment.)*(Your initials here)A written estimate can be prepared AT MY REQUEST before treatment/procedures are performed. I realize that the actual expenses may differ from the estimate dependent on the patient’s condition and length of stay in the hospital. Southern Hills Animal Hospital will try to contact me if emergency treatment is required. I will be responsible for expenses incurred in an emergency when I cannot be reached or there is no time to contact me. I will be fully responsible for monitoring the ongoing expenses and will be fully responsible for all expenses incurred through the animal’s diagnosis and treatment.*(Your initials here)“No Shows”, Cancellations & Pet AbandonmentClients must contact Southern Hills Animal Hospital by 3:00 pm on the day prior to scheduled appointments to notify us of any changes or cancellations (Monday appointments by 3:00 pm on Friday). If no prior notification is given, clients will be charged $50.00 for the missed appointment. If clients are more than 15 minutes late to a scheduled appointment, they will be seen as a work in (between other standing appointments). This policy will also apply to established clients who have a history of failing to keep scheduled appointments. After 2 “No Call – No Shows” (effective 9/22/22), an exam prepayment of $50 will be required to schedule future appointments and will be applied to that client’s next appointment balance.*(Your initials here)It is the client’s responsibility to notify Southern Hills Animal Hospital if they are unable to pick up their pets on the agreed-upon date. If there is no contact within 5 days after the agreed-upon date, pet(s) will be considered abandoned and appropriate action will be taken.*(Your initials here)Patient RecordsWith client authorization, vaccination information will be released in print and/or electronically to other veterinary hospitals, boarding facilities, and groomers.* Please contact me first. I give Southern Hills Animal Hospital authorization to share these items.Photography ReleaseWith permission, Southern Hills Animal Hospital may use client’s pet’s photo and first name in marketing materials, which may include but are not limited to, social media accounts like Facebook and Instagram, sohillsvet.com, in-hospital signage and other forms of advertising.* Please contact me first I give Southern Hills Animal Hospital authorization to share these itemsRight of RefusalI understand Southern Hills Animal Hospital reserves the right to refuse any requested services, including euthanasia if the veterinarians (and/or staff) deem it medically unnecessary.* I understandI have read all terms and agree to all conditions described*Reset signature Signature locked. Reset to sign again (Sign here)PhoneThis field is for validation purposes and should be left unchanged.Δ
