New Patient Consent Form

Thank you for considering Doorstep Veterinary Care as your pet(s)’ provider for veterinary services. We strive to provide the highest quality of care with your pet(s) in familiar settings, to help decrease the stress, fear, and anxiety associated with traditional veterinary clinic visits.

Please review the following items and select your preferred option for each item.

PHOTO RELEASE AND SOCIAL MEDIA CONSENT

Does Doorstep Veterinary Care have your permission to use and/or publish photographs or videos of you and your pet(s) in print and/or electronically on social media, our website, and other forms of related media? Your name and personal information will never be shared, unless permission is granted. By authorizing photo release/social media consent, you hereby release and discharge Doorstep Veterinary Care, its representatives, and employees, from all claims, demands, and liabilities arising out of use of the photos and/or videos for any lawful purposes such as for publicity, illustration, advertising, and Web content.

Do you Authorize the above?(Required)

TREATMENT CONSENT

I hereby authorize the veterinarian to examine, prescribe for, and/or treat my pet(s).

Do you Authorize the above?(Required)

PAYMENT CONSENT

I assume responsibility for all charges incurred in the care of my pet(s). I understand that PAYMENT IS REQUIRED IN FULL AT THE TIME SERVICE IS RENDERED. I recognize that financial concerns should be discussed PRIOR to exam and treatment, and that a cost estimate can be provided before the visit if there are any financial concerns.

​

Payment via Zelle, Cash App or Venmo is preferred. However, we also accept the following forms of payment: Visa, MasterCard, Discover and American Express.

Cash and personal checks (made payable to Doorstep Vet Care) are also acceptable

Do you acknowledge and agree with the terms above?(Required)

General Policy

It is required that a Veterinarian-Patient-Client-Relationship (VPCR) exists prior to prescribing medications and providing a diagnosis/treatment(s). To establish and maintain a VPCR, we require that the patient be examined at least once yearly. The VPCR can be terminated at any time by either Doorstep Veterinary Care or the client.

COVID-19 POLICY

  • All clients and family members present MUST wear a mask or cloth face covering over their nose and mouth during the entire visit despite your COVID-19 vaccination status.
  • In order to protect you and our staff, we are asking about symptoms and exposure to COVID-19:

    • If you are experiencing any NEW symptom(s), unrelated to a pre-existing health problem, such as cough, fever, chills/shaking, fatigue, shortness of breath/difficulty breathing, headache, loss of taste or smell, muscle aches/pains, sore throat, congestion or runny nose, nausea/vomiting, or diarrhea - PLEASE RESCHEDULE YOUR APPOINTMENT 14 days after the onset of your symptoms.

    • If you have tested positive, or have been exposed to someone with presumptive or confirmed COVID-19, PLEASE RESCHEDULE YOUR APPOINTMENT 10-14 days after the start of your quarantine, or 2 days after a NEGATIVE COVID-19 test result.
  • You understand that COVID-19 virus spreads through close contact from person to person, including between people who are physically near each other (within about 6 feet), and that people who are infected but do not show symptoms can also spread the virus to others. With that said, Doorstep Veterinary Care will maintain all appropriate safety measures during the visit, but you accept all health risks associated with COVID-19 transmission, and you will not hold Doorstep Veterinary Care accountable for any possible COVID-19 exposure.

Do you acknowledge and agree with the terms above?(Required)

Financial Polices

  • Payment is required in full at the time service is rendered.
  • We accept contactless payments, cash, checks and credit cards.
  • It is the client’s responsibility to request an estimate prior to services rendered.
  • Unpaid balances will incur a service charge of 1.5% per month.

Return Policy/Gift Certificates

  • Prescription medications are non-returnable, and their sales are final.
  • Any non-prescription items that are returned will be credited to the client’s account if returned within 14 days of purchase.
  • All discounts and promotions are only honored if services and products are paid in full.
  • All gift certificates and referral cards must be presented at the time of check-out.

Safety Policy

Clients are responsible for the behavior of their pet(s). Please inform Doorstep Veterinary Care if your pet(s) has a history of aggression and/or severe anxiety.

Do you acknowledge and agree with ALL the terms above?(Required)
I have read and fully understand the policy and procedures regarding being a client of Doorstep Veterinary Care. I understand that by typing my first and last name in the boxes below constitutes as a legal signature confirming that I acknowledge and agree to the terms above.
MM slash DD slash YYYY