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E-Mail Address (required) :
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Employer (required)
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Selection :
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Spouse/Partner/Co-Owner Employer
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Pet's Name (required)
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Age: Years, Months
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Type of Pet (required) :
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Breed
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Sex (required)
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Neutered/Spayed
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Are your pets vaccines current?
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Do you have pets medical records?
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Are your pet's medical records at another veterinary practice? If yes, please call that practice and have those records emailed to staff@harborroadvet.com.
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Name of Former Veterinary Practice
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Would you like us to call or text you for your appointment
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Reasons or conditions that prompted your visit?
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Special requests or conditions?
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Please list any additional pets here
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You may use my pet's image and name on: Harbor Road's Facebook page Harbor Road's website in-clinic postings you may not use my pet's image
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HARBOR ROAD POLICIES CREDIT POLICY
Harbor Road Veterinary Hospital has a “no billing” policy, which enables us to keep our fees low. All services performed at Harbor Road Veterinary Hospital are to be paid for when rendered. We do not accept postdated checks, but we do accept cash, checks, MasterCard, Visa and Discover. There is a billing charge of $1.00 per month on all statements, and an annual finance charge of 18% on all outstanding balances. Recovery of this debt will be pursued through our collection agency, and all costs associated with collecting any outstanding balances will be added to the balance due Harbor Road Veterinary Hospital. You agree to reimburse us the fees of any collection agency, which may be based on a percentage at a maximum of 50% of the debt, and all costs and expenses, including reasonable attorney fees, we incur in such collection efforts.
WAIVER OF LIABILITY
If my animal(s) should injure themselves in an escape attempt, refuse food, soil themselves, become ill or die while in the hospital, I will hold Harbor Road Veterinary Hospital and its staff free of any responsibility and/or liability in the absence of gross negligence.
POLICY FOR HOSPITALIZED & BOARDED ANIMALS
For reasons of health and safety, all animals hospitalized or boarded at Harbor Road Veterinary Hospital are required to have current vaccinations and be free of fleas. If necessary Harbor Road Veterinary Hospital will vaccinate animals to bring them up to date and/or will apply a topical flea treatment if fleas are found. All costs
for these services will be the responsibility of the pet’s owner. |
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Please type your name as acknowledgement that you have read and accepted Harbor Road's policies.
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