Owner's Name *

First Name

Last Name

Preferred Phone Number *

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Spouse/Co-Owner's Name, if applicable

First Name

Last Name

Spouse/Co-Owner's Phone Number, if applicable

(###)

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Every effort is made to begin your appointment promptly at the scheduled time. Late cancellations or failure to appear for an appointment will incur a fee. *

I understand:

Yes

No

While I'm at the office, I'm focused on patient care and may not be able to check email during the day. If you experience an emergency or delay, please alert me by phone call or text message at (845) 399-9844. Without notice, I will wait 15 minutes past your scheduled appointment. After that time, the appointment is considered missed. *

I understand:

Yes

No

Appointment Arrival Times *

Please arrive early enough to potty your dog prior to the appointment. Park in front of the entrance ramp, or near the office sign. Dogs who are scheduled to receive ozone insufflations must have evacuated their bowels within 6 hours of the visit. I understand:

Yes

No

Cancellation Policy *

We are all human, living in a world with multiple obligations and challenges. A great deal of effort is made to accommodate illness, emergencies, inclement weather, and other urgent needs. I do not want you driving when it isn’t safe, nor do I want you to show up sick to my office, or to ignore a family emergency. That said, I have a 48 hour cancellation and rescheduling policy. I understand:

Yes

No

*

To avoid paying for a missed appointment, please reschedule a minimum of 48 business hours prior to the visit. This means a request for Monday or Tuesday appointments must be made by Thursday or Friday morning. A phone call or text is preferred to alert of last-minute changes to scheduling. By checking the box below, you affirm your awareness and agreement with this scheduling policy. Please appreciate that this measure is in place to ensure the efficient functioning of the practice, and to accommodate the needs of all clients and patients.

Yes, I understand and agree.

Fee Schedule: How much will this cost? *

Please note that clients are charged by time, not by services rendered. An initial, new patient appointment is up to one hour in the office. The fee of $300 covers the visit, plus a review of supplied medical records. Once a patient has been evaluated and treated, we can schedule follow-up office visits and/or phone consultations to check progress. Follow-up office visits are $160-$340 depending on how much time is allotted for the visit. Additional fees apply for add-on products such as Adequan or Pentosan injections, and any dispensed medications, herbs, or supplements. I understand:

Yes

No

Payment Methods *

I accept cash, check, Venmo, or Zelle Pay. Prices subject to change, please confirm the fees at time of booking. CREDIT AND DEBIT CARDS NOT ACCEPTED. I understand:

Yes

No

I understand the following: *

This is not a traditional veterinary office. The intake protocol and scheduling process is different from what you are used to.

Urgent and same-day appointments are not offered. Please contact your primary care veterinarian, the nearest ER clinic, or urgent care clinic for health emergencies. The Resources tab on this website lists ER options.

This is a highly personalized and individual approach to pet health care. The time invested by you and by me is reflected in the fee structure.

Holistic modalities are rarely a quick fix. Natural therapies take longer to show benefits, and build on one another synergistically. Many patients are using multiple modalities, supplements, and herbal medicines combined to maximize effects.

My approach is not the best fit for every pet or pet parent. You deserve to find a veterinarian who aligns with your values and preferences! Best results come from a harmonious team-work relationship.

Date *

MM

DD

YYYY

By sending in this form, you are confirming receipt and understanding of the policy and processes outlined on this page and in this form. *

By checking this box and typing my full name in the signature box above, I acknowledge that I am electronically signing this form. I've read and agree to your terms of service.