Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Who else is authorized to make decisions about your pet's healthcare? *

First

Last

Phone

How did you find out about our hospital? If you were referred by someone, who should we thank? *

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a second pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a third pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fourth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Do you have a fifth pet? *

Yes
No

Pet's Name *

Species (dog, cat, etc.) *

Breed (copy) *

Age/Date of Birth *

Sex *

Male
Neutered Male
Female
Spayed Female

Does your pet have a microchip identification? *

Yes
No

What is the microchip number?

Financial Policy

We strongly feel that our clients and patients deserve the very best veterinary care we can provide. We do as much as we can to try and hold down the cost of veterinary care. Further, we feel that everyone benefits when definitive financial arrangements are agreed upon. The following is a summary of our payment policy.

1. ALL PAYMENT IS EXPECTED AT THE TIME OF SERVICE
Valley Veterinary Clinic accepts cash, personal checks, VISA, MasterCard, Discover, Care Credit and ScratchPay (these are 3rd party providers that offers monthly, NO INTEREST payment plans. You must apply for these prior to your appointment if you plan to use them)
2. RETURNED CHECKS
Valley Veterinary Clinic charges $45 for returned or NSF checks.
3. FINANCE CHARGES
Unpaid balances will accrue monthly finance charges of 3%
4. ESTIMATES
Valley Veterinary Clinic can provide Treatment plans in the case of major procedures and hospitalization. A deposit may be collected equal to 50% of the high side of the estimate fee.
5. INSURANCE
Valley Veterinary Clinic is happy to assist clients with filing their pet insurance claims. Please note that services are rendered to you, not to your insurance company. An insurance company rarely covers the entire cost of services. Therefore, services must be paid for in full to the clinic prior to filing insurance claims.
6. MISSED APPOINTMENTS/LATE CANCELLATIONS
Broken appointments represent a cost to us, to you, and to other clients who could have been seen in the time set aside for you. Cancellations are requested a minimum of 24 hours, not including weekends, prior to any appointments. We reserve the right to charge $40 for missed/late-cancelled appointments, $100 for missed/late-cancelled surgeries. Excessive abuse of scheduled appointments may result in discharge from the practice.

I have read and understand the Valley Veterinary Clinic Financial Policy. I agree that if it becomes necessary to forward my account to a collection agency, in addition to the amount owed, I also will be responsible for the fee charged by the collection agency for costs of collection.

We use an automated service called Weave that will email/text you your pet’s veterinary reminders and will also send confirmations of appointments you make. We also use it to text you updates about your pet if they are in hospital with us! Please make sure the primary number you provide is able to receive text messaging. *

I have read and accept it

New Client Form

New Client Form

Financial Policy

Ready To Visit

Questions?

Address

Contact Information

Hours

We proudly serve the pets of Glasgow, MT and the surrounding areas:

Wolf Point

Malta

Scobey

Opheim

Fort Peck

Plentywood