Owner's Name *

First Name

Last Name

Phone Number *

(###)

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Appointment Scheduling *

Fee Schedule: Please note that farm visits are charged by time, travel (mileage & driving time), and the number of horses seen. They are not charged by services rendered. ​​An initial appointment is a one-hour minimum. Once a horse has been seen, we can schedule phone consultations to check progress, if that is the best way to move forward. There is a minimum $400 total fee per farm visit, including all horses treated and call fees. Travel Fees: Farm visits within a 20-minute drive from Olivebridge are $75. My ability to drive long distances for one or two horses is very limited, and the travel fee increases with mileage and drive time. Please note that the fee can be divided among horse owners, with a minimum charge of $25 per horse. If there are records and/or X-rays to review prior to a visit or consultation, there is an additional $35 for 10 minutes, in addition to the treatment session fee. Telemedicine is $100 for the first 30 minutes and then $35 per additional 10 minutes. Payment Methods: I accept cash, check, Venmo, or Zelle Pay. Prices subject to change, please confirm the fees at time of booking. *By sending in this form, you are confirming receipt and understanding of the policy and processes outlined on this page and in this form*

Yes, I've read and agree to your terms of services

Cancellation Policy *

I commit to providing a minimum of 24 hours' notice in the event of a cancellation. I understand that late cancellations or missed appointments may result in a cancellation fee. By checking the box below, I affirm my awareness and agreement with this policy. I 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.

Date *

MM

DD

YYYY

*

By checking this box and typing my full name in the signature box above, I acknowledge that I am electronically signing this form.