Welcome to the Danbury Cat Clinic! Thank you for giving us the opportunity to care for your feline friend. Please help us better meet both of your needs by taking a few minutes to review our policies and confirm the information that we have on file. All new clients are required to leave a non-refundable $35 deposit at the time an appointment is scheduled. It is to be verbally stated at the time to the client when scheduling the appointment. The deposit is applied to the clients bill when they keep their appointment. If for any reason they need to reschedule, we ask the client to give us 24 hours notice. The deposit is forfeited if they either do not reschedule, give us less than 24 hours notice or the client does not show up for their appointment. Since we carefully review all previous medical records prior to all our new patients appointments, this process takes time for the nurse as well as the doctor. If the client fails to keep their appointment the deposit acts as a processing fee.Client's Full Name(Required) First Last Spouse/Partner Name First Last Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How did you hear about the Danbury Cat Clinic? (Please check all that apply) Website Facebook Instagram Google or other Search Engine Sign/Location Newspaper Rescue Agency Word of Mouth Other Other PAYMENT POLICY: PAYMENT IS DUE WHEN SERVICES ARE PROVIDED. We will gladly provide you with a written treatment plan for all your visits. Deposits may be required for certain services and for your convenience we accept CASH, CHECKS, and all MAJOR CREDIT CARDS. We also accept CARE CREDIT, a medical credit card for those that qualify. Please ask one of our team members for more information.Signature of Client or Responsible Party(Required)Date(Required) MM slash DD slash YYYY We can now securely store your credit card number. Would you like us to keep your card on file?(Required) Yes No Initial(Required)SOCIAL MEDIA AGREEMENT: I grant the Danbury Cat Clinic permission to post my pet’s photo on the Danbury Cat Clinic’s social media. Signature of Client or Responsible PartyDate MM slash DD slash YYYY Follow us on Facebook and Instagram: @danburycatclinic Check out our new scheduling app PetDesk Please review our policies and sign before for treatment. NOTICE TO ALL OUR CLIENTS: PER CONNECTICUT STATE LAW, ALL CATS MUST BE VACCINATED AGAINST THE RABIES VIRUS.Initial(Required) Dr. Fanning’s Standard of Care states that our patients are required to maintain all doctor recommended core vaccines for the health of our patients to help prevent the spread of infectious diseases and for the safety of our staff. ALL DOCTOR-REQUIRED CORE VACCINES WILL BE ADMINISTERED AT THE TIME OF YOUR APPOINTMENT. Initial(Required) A current Doctor/Patient relationship is mandatory to obtain prescription medications and diets. To maintain a current Doctor/Patient relationship, it is Dr. Fanning’s Standard of Care that adult cats under 8 years old are required to have a preventative exam once a year and senior cats over 8 years old are required to have a preventative exam once every 6 months. If your cat has any chronic medical conditions, they must come in routinely per veterinary recommendations. Initial(Required) PER CONNECTICUT STATE LAW, a Driver’s License number is required for all controlled & monitored drugs either administered or dispensed. Issuing State DRIVER'S LICENSE # Your appointment starts promptly 15 minutes prior to your scheduled appointment time. We ask that you arrive on time. Veterinary visits are often very stressful for cats. That’s why our staff is trained in Fear Free techniques, and we don’t rush through appointments. When you’re even five minutes late, it puts us behind for the rest of the day. Arriving early avoids this and allows us time to have our veterinary nurse start your cat’s visit with us on the right paw. Initial(Required) If you arrive with less than 10 minutes available before your scheduled appointment and we do not hear from you, we will automatically reschedule your appointment to a later date and time. Initial(Required) If you do not show up for your scheduled appointment and have not canceled the appointment 24 hours in advance, we will charge your account a No-Show Fee, equivalent to the cost of the scheduled exam. If you have multiple No Shows, you will be required to leave a non-refundable deposit for the cost of the scheduled exam at the time of booking. Initial(Required) A 30% deposit payment is required at the time any surgery is scheduled. This deposit is only refundable if the procedure is canceled with 3 days’ notice. Initial(Required) I verify that I have read and acknowledged the Danbury Cat Clinic’s Standard of Care and No Show/Cancellation Policies as listed on this form. Failure to comply may result in being discharged from the Danbury Cat Clinic. Initial(Required) Signature of Client or Responsible Party(Required)Date(Required) MM slash DD slash YYYY Thank you for your understanding and cooperation, the Danbury Cat Clinic Team 203.748.CATS (2287) danburycatclinic.com Danbury Cat ClinicCAPTCHA Δ
