New Client Form

We thank you for allowing us to take care of your pet. In order to provide the best possible animal care, we require that all professional fees are due at the time services are rendered. We accept several payment options. They include cash, personal checks, debit cards, as well as credit cards. There has to be a $30.00 or 10% (whichever is greater) service charge for any check returned unpaid. Care Credit payment plan: A receptionist will be happy to discuss this monthly payment plan with you. Approval from Care Credit is required. We routinely provide written estimates. Critical patients that need extended hospitalization will have the balance updated daily. We are glad to work with you and give multiple estimates in order to help us provide medical care that your pet may need. In the end, we always want what is best for you and your best friend.

I have reviewed the information on this questionnaire, and it is accurate to the best of my knowledge. I understand that prior to treatment, a full explanation of the procedure(s) involved will be given by the veterinarian (and/or staff) in the care of my animal(s). I agree to pay for all services rendered by this office. I also understand that should my account become delinquent, my information may be released to a third party collection agency to assist with collecting fees associated with treatment rendered by this office.

I hereby grant full permission to Buckeye Veterinary Clinic, LLC to use either my photograph and name (if necessary) or my pet’s photograph and name (if necessary) in any publication or advertising materials (printed or electronic). This consent also serves to waive all rights of privacy or compensation which I may have in connection with the use of my photograph and/or name or my pet’s photograph and/or name.