New Client Form

I authorize Westgate Pet Clinic, its employees, to photograph and publish any of the images taken of my pet
and/or me. I am aware that these images may be used for a variety purposes including, but not limited to, appearing
on the clinic website, facebook, instagram, etc. I understand that any personal information, other than my pet’s name,
breed, age, and my name will not be attached to this posting without my consent. Should I decide to withdraw my
photo at a later date, I am aware that I must give a written request before my photo is withdrawn. By signing this form,
I acknowledge that I understand and agree to the statements listed above.

Thank you for choosing Westgate Pet Clinic. Our primary mission is to deliver the best and most comprehensive
veterinary care available for your pet. An important part of the mission is making the cost of optimal care as easy and
manageable for our clients as possible by offering several payment options.

Westgate Pet Clinic requires payment in full at the time of your pet’s appointment and/or at the time of discharge.

Payment Options:

You can choose from: Cash, Check, Visa®, MasterCard®, American Express®, Discover Card®, CareCredit®, ©Scratchpay.

Convenient Monthly Payment Options^* from the CareCredit® Healthcare credit card. ^{*Subject to credit approval.}

• Allows you to begin treatment today and pay over time. Instant approval and ask about 0% financing.

Convenient Monthly Payment Options^* from ©Scratchpay ^{*Subject to credit approval}

• Allows you to begin treatment today and pay over time. Instant approval and APR varies.

Policy:

Due to the increasing number of “No-Shows” and “Same Day Cancellations”, combined with high demand for
services, there will be a charge for missed appointments and cancellations. It is the responsibility of the client to
arrive for their appointment on time and to cancel, if needed, with at least 4 hours notice. This allows us to
accommodate other patients who may need prompt medical care. In order to avoid a cancellation fee, please call us
24 hours in advance for anesthetic procedures and 4 hours in advance for appointments.

In conjunction with our No-Show, Cancellation Policy all appointments and anesthetic procedures will now require a
credit card on file to hold your appointment or procedure date. You will be asked for credit card information at the time
of scheduling your appointment/procedure.

This information will be held on a secure server, and may be used for the following purposes:

• Payments not collected from you at the end of your visit without communication at the front desk.
• No show or late cancellation charges.

This is an advantage since it makes check-out easier, faster, and more efficient.
This in no way will compromise your ability to dispute a charge or question any of the services provided.
If you have any questions about this payment method, do not hesitate to ask.

• Appointment No-Show Fee = non-refundable $80.00
• Anesthetic Procedures No-Show Fee = non-refundable $250.00

Westgate Pet Clinic charges $20 for returned checks. We are here to provide the best veterinary care
available for your pet. Please note, you must be 18 years or older to sign below. If under 18, please have
your parent or legal guardian sign.