Page 1 Lofton Creek Animal Clinic CLIENT/ INFORMATION ACCT# (clinic use) Welcome to Lofton Creek Animal Clinic. To ensure the best care possible for your pet, please complete this form. Thank you for the opportunity to care for your pet(s). Today s Date: Owner s Name: Co-Owner s Name: Address: City: State: Zip: Primary Contact Number: Secondary Contact number: E-Mail Emergency Contact Name: Number How did you find out about us? Pet Information Pet 1 Name: Dog Cat Breed: Color: Age/Birth: Sex: Spayed/Neutered Y N On Heartworm Preventative? Y N Type:
Page 2 On medications or prescription diets? Previous Veterinarian or Clinic Name: Pet Information Pet 2 Name: Dog Cat Breed: Color: Age/Birth: Sex: Spayed/Neutered Y N On Heartworm Preventative? Y N Type: On medications or prescription diets? Previous Veterinarian or Clinic Name: I Give permission that photos taken of me or my pets to be put on social media like Facebook. I Decline any photos taken of me or my pets to be put on social media like Facebook. TO PREVENT THE SPREAD OF INFECTIOUS DISEASES AND INTERNAL/EXTERNAL PARASITES, ANIMALS THAT ARE ADMITTED TO OUR CLINIC MUST BE CURRENT ON ALL VACCINES UNLESS BY DOCTOR S AUTHORIZATION. I authorize the doctor on duty to provide medical care, vaccines and parasite control for my pet. I give LCAC permission to video and photograph my pet. I understand that all FEES ARE PAYABLE AS SERVICES ARE RENDERED AND PATIENTS ARE DISCHARGED FROM OUR CLINIC. We do not offer any form of billing. We accept cash, VISA, Mastercard, American Express and Care Credit as forms of payment. We no longer accept checks. A deposit may be required for major procedures. This also applies to extensive treatment of severely ill patients or boarders staying longer than one week unless prior arrangements have been made. All information I have provided here is true to the best of my knowledge. I have read and understand the Terms of Service Owner s Signature Date
Page 3 LOFTON CREEK ANIMAL CLINIC POLICIES All animals must be on a leash or in a carrier when entering the clinic. Rabies vaccination has to be up to date for any doctor or technician visit. If proof of current rabies is NOT provided, a rabies vaccine will be given with a doctor s exam (Fees will apply). We will also request a copy of a previous vet records and vaccines for our records. A. Boarding Policies: All animals need to be current on vaccinations. This includes rabies, DHLP-P, and bordetella for dogs. FVRCP and rabies vaccines are required for cats. Any animal boarding with us for 3 or more days will require a complimentary bath before going home. All boarding pets(regardless of duration of their stay) will receive a flea elimination pill the day of departure at the owner s expense. Any pets boarding during the holidays will require a 50% deposit at appointment time in order to hold boarding slot. B. Emergency Appointment(s): We do our best to accommodate emergencies during business hours. We recommend you call ahead if at all possible so we can be better prepared for your arrival. Upon arrival to our clinic, a $100 emergency fee must be paid before your pet receives an initial examination and evaluation by our veterinarian. If your pet requires medical assistance after hours LCAC recommends calling Affiliated Veterinary Emergency Center (904)642-5911 C. Flea Free Facility: Lofton Creek Animal Clinic is a Flea Free Facility. In order to insure the wellness of ALL of our patience, any animal found to have fleas while in LCAC will be given a CapStar at owner s expense. Capstar is an oral tablet that kills adult fleas within minutes for dogs, puppies, cats and kittens 4 weeks of age and older and 2 pounds of body weight or greater. D. Payment Policies: All payment must be received upon services rendered. LCAC does not accept checks.
Page 4 E. Prescription Policies: We request at least a 24 hour notice for medication refills. There is a $15.00 (per pet) annual pharmacy monitoring fee for prescriptions written for medications that you choose to be filled outside of LCAC. Please allow 3-5 business days for written prescription. Due to human error all prescriptions filled outside LCAC will require a written prescription to be picked up and sent to the pharmacy by the client. F. Lab work Results Policy: Please allow 3-5 business days for Lab work results to return. All results will be called and given at the end of the business day due to analysis from the doctor. G. Cancellation Policies: If at any time you need to reschedule an appointment, a 24 hour notice of cancellation is needed. If no notice is given 24 hours before appointment time, a $53.00 cancellation fee will be added to your account. A 24 hour notice is also required to cancel a surgical procedure. Failure to cancel the surgery with at least a 24 hour notice will result in a $100 charge added to your account. If you are late more than 10 minutes you will be asked to reschedule your appointment and charged a no show fee of $53. This is to ensure all clients and patients get the best possible service. H. Social Media Policy: All photos taken in Lofton Creek Animal Clinic are subject to be put on social media like the Lofton Creek Animal Clinic s Facebook page. You reserve the right to decline this option by checking the decline box below. I Decline any photos taken of me or my pets to be put on social media Thank you very much for your cooperation. LCAC Staff Print name Signature Date
Page 5 Come bring your kiddo in for a pawfect pampering on Tuesdays at Lofton Creek Animal Clinics and get 50% off all spa day packages. Spots fill up quickly, so call now to schedule an appointment (904)225-1044. Doggy Day Spay Includes: Bath Ear cleaning External anal gland expression Nail trim Package 1: under 30lbs $25.00 (Regular price $50) Package 2: 31lbs to 60lbs $30.00 (Regular price $60) Package 3: 61lbs and up $35.00 (Regular price $70) Cat package: $25.00 Bath Nail trim Other a la carte services available on Spa Day Nail Dremel: $15.00 Soft Paw application/nail trim (cats only): $25.00 Ear Plucking: $15.00 Internal Anal Glands Expression: $20.00
Page 6 All Spa Day drop offs that come in extremely soiled and require more than one bath or take more than the 20 minutes allotted bath time, will be charged $1 per extra minute it takes to wash your pet. Spa Day s are a luxury day for our fur-babies and we would like for everyone to enjoy their baths and give each and everyone the proper amount of time and care they have paid for. Thank you for understanding. -LCAC
Page 7 Lofton Creek Animal Clinic offers a $5.00 a day discount exclusively to ALL active medical patients. It s our way of saying thank you for being loyal. NEW BOARDING PRICES Active Patient Pricing: All cats: $25 Dogs under 30lbs: $30 Dogs over 30lbs: $35 Day boarding: $18 Non-active Patient Pricing: All cats: $30 Dogs under 30lbs: $35 Dogs over 30lbs: $40 Day boarding: $23