New Client Application

Name(Required)
Address(Required)
Does this number accept text messages?(Required)
Other Responsible Party (second pet parent or emergency contact person):
How did you learn about our hospital?

Pet Information

Sex
Max. file size: 5 GB.
Which first visit are you requesting?
At All God’s Creatures Holistic Healthcare, we recommend regular examinations, vaccinations based on environment/ exposure, balanced diets, and parasite preventions to ensure your pet receives the very best care. Please select one of the following.(Required)
Photo/Name Release: All God’s Creatures may use images of our client’s pets to demonstrate the care and attention that they receive here. When pets are happy and calm during treatment and care, it helps other pet owners to see how enjoyable veterinary care can be. We only use pet names and not owner names in our content. By signing below, I hereby give All God’s Creatures the right to use the name, video, and photographs of any of my pets in connection with its website and any promotional materials in any and all media, including, but not limited to, printed material, internet, social media, and film for display, public relations, and marketing. I hereby acknowledge receipt of adequate consideration and waive the right (i) to charge or be compensated for the use of the pictures, and my pet(s)’s name(s), and (ii) to inspect or approve the images prior to any form of usage. I understand that the images may be modified to use as design elements(Required)
Professional fees are due in full at the time of services rendered. Payment Options: Cash, Checks, All Major Credit Cards, and Scratch Pay Returned Checks: We charge a $55 fee for returned checks. This returned check charge and the client balance must be paid in full before scheduling any further appointments. A reservation fee is required for ALL New Client examinations. Cancelled Appointments: We ask that if you must cancel or reschedule your appointment, you do so greater than 24 hours of your appointment (72 hrs for anesthesia appointments). Payment is due at the time of service(s)- If your pet is hospitalized, having unplanned surgery or other care, a deposit may be required and balance will be due when your pet goes home. I understand that I am responsible for all charges for the care of my pet(s) provided by All God’s Creatures Holistic Healthcare, LLC. A finance charge of 1.5% monthly (18% Annual Percentage Rate) will be charged on any past due balance should the account become 30 days delinquent. If the account is assigned to a third party collection agency for collection, I understand that a charge of 33% of the unpaid balance at the time of assignment will be added to the account to cover the costs and administrative fees. If a suit is filed and taken to court, a 45% fee of the unpaid balance will be added to the account. I agree to pay the collection charge, plus interest, court costs and attorney fees if applicable.
I understand and agree to the above terms.(Required)
I am the legal owner or responsible party seeking veterinary care for the pet/pets identified and I certify that I am eighteen years of age or over.(Required)