New Patient Intake

Terms and Conditions

By submitting this form, I acknowledge and agree to the following:

1. Treatment Authorization
   I consent to the examination, treatment, and necessary procedures for my pet by Tier 1 Veterinary Medical Center (VMC). In emergencies, treatment may commence without prior consultation. I authorize Tier 1 VMC staff to provide care and perform any treatment, including the administration of anesthesia and surgical procedures, they consider reasonable and necessary. I understand that, with any medical or surgical procedure, there are risks involved, including the risk of death. I acknowledge that no guarantee or assurance is being made as to treatment results.

2. Financial Responsibility
   I am financially responsible for all services rendered to my pet. Payment is due at the time of service unless other arrangements are made in advance. Estimates are approximations, and the final bill may vary. The fee for a scheduled exam is $90.00, and a walk-in exam is $149.00. A 3% surcharge will be applied to all credit card payments.

3. Medication and Prescription Policy
   I understand the policy regarding medication prescriptions, including the use of generic brands and the procedures for medication refills. Prescription refills may take up to 72 hours to process.

4. Behavioral Assessments
   I understand that Tier 1 VMC does not perform behavioral assessments, and it is my responsibility to notify the appropriate animal care authorities if I believe my pet could be dangerous.

5. Pet Surrender and Relinquishment
   Tier 1 VMC does not accept surrendered or relinquished pets under any circumstances. Employees are strictly prohibited from accepting the transfer of pet ownership while employed or on hospital premises.

6. Disclaimer for Items Left
   I understand that if I leave items with my pet, Tier 1 VMC is not responsible for their return.

7. Photography and Media Consent
   I allow Tier 1 VMC to use images or videos of my pet for medical, educational, or promotional purposes without compensation. (☐ Yes ☐ No)

8. Right to Refuse Service
   Tier 1 VMC reserves the right to refuse service to anyone at any time for any reason.