New Client Form

We are so excited to document you pet’s visit to our clinic and often include photos and videos to our social media pages. I, the undersigned, hereby agree to this Video and Photographic Release and Authorization for Marketing (“Release”). I voluntarily authorize Scotts Valley Veterinary Clinic to video, audio record and photograph my pet in any manner and to disclose and use for marketing purposes on social media, including Facebook, Instagram, YouTube and the website of Scotts Valley Veterinary Clinic (collectively “Social Media”). I acknowledge and agree that I may revoke this authorization at any time by notifying Scotts Valley Vet Clinic in writing. However, once the media-related information is published on Social Media, Scotts Valley Veterinary Clinic has no control over subsequent third-party redisclosure; thus, the media-related information cannot ever be completely removed from Social Media or the Internet generally. This means that even if I revoke this consent, Scotts Valley Vet Clinic will be unable to completely remove the media-related information. Such revocation will only apply to future disclosures but will be noted in your pet’s record. I further acknowledge and agree that I will not receive compensation for signing this document, being video and audio recorded or photographed, or for any use of the media-related information; that I have no right to inspect or approve the media-related information prior to its disclosure on Social Media; and that after I sign this document, the media-related information will no longer be protected by medical privacy laws. I hereby grant Scotts Valley Veterinary Clinic the right and permission to use the media-related information to reproduce, edit, exhibit, project, display, copyright, publish, in whole or part, on Social Media. I hereby indemnify Scotts Valley Vet Clinic against any damages, losses, liabilities, judgments, costs, or expenses (including reasonable attorney fees and costs) arising from any third-party claims that relate to the of the media-related information.

If myself or my secondary contact are both unreachable by immediate phone call, I hereby authorize Scotts Valley Veterinary Clinic to perform necessary diagnostic/medical/treatment or surgical procedures on my pet as appropriate or deemed necessary. I understand that I can pause or terminate treatment at any time by contacting the clinic directly. In the event my pet may need to be treated at an emergency or specialty clinic, I authorize my pet’s records/radiographs and any other pertinent information to be released to said parties. I understand that Scotts Valley Vet Clinic will not share my information with any third parties directly. Lastly, in the event my pet transfers ownership, I authorize the release of medical information to the new owner upon request by myself or secondary owner.

Payment is due at the time services are rendered. In order to focus on our patients’ needs, customer service and minimizing costs, we do not bill or do extending billing. A deposit may be required for hospitalized cases and for major surgical procedures. The balance (in full) is due when the patient is discharged from our clinic. We accept all major credit cards, cash and personal checks (with proper identification). I agree that under the circumstance I cannot afford the care I elected to have performed with a signed estimate, I agree to pursue third party financial lenders (ex Care Credit or Birch Bark Foundation). In the unlikely event that a balance is to accrue, any balance over 30 days old will incur a $5.00 per month service charge AND an additional monthly interest rate of 1.5%.

We require a deposit for new client appointments, existing patient surgeries and specialty ultrasounds. This deposit is non-refundable without a 24-hour notice for cancellation. Please understand that adequate notice is required in order for SVVC to utilize that appointment time for another patient in need. For no shows or cancellations without a 24-hour notice, a full office visit fee will be applied for a missed exam and $200 for surgeries or specialty ultrasounds at the discretion of Scotts Valley Vet Clinic. Fees are not covered by insurance and need to be paid before your next appointment. PLEASE do not ask our staff to waive this fee. In order to keep a small, non-corporate family owned veterinary office like ours open, it is necessary to collect late/cancellation/no show fees. We VALUE you as a client and hope that you value our level of care and us as your veterinary practitioner by honoring this policy.