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  • Client Information:

  • MM slash DD slash YYYY

  • * We are a paper-light practice, using email regularly! Your email address will only be used within our business and pharmacy services to send you reminders for your pets and information from the vet.

  • Additional Contact:

  • Payment Information

    Full payment is due at the time of service and a deposit may be needed prior to treatment depending on the services provided. We accept, cash, checks, and most major credit cards, including Care Credit. We do not bill or invoice our clients. There is a $25.00 fee for any returned checks.

  • CARECREDIT & other credit/debit cards:

    Please read & initial in the box to confirm your understanding:
  • Please initial here that you understand we CAN NOT make exceptions to CARECREDIT's policy and will require card holders to be present with photo ID in order to use their CareCredit card

  • Release of Information:

    It is our policy to automatically share/release our patient’s records to other animalrelated businesses that ask for them. We extend this professional courtesy to groomers, boarding facilities, other vet offices, and specialists for the welfare of our patients.

  • Authorization of Ownership:

    I authorize the following people to act as owner in my absence and on my behalf for any of my pets listed in my medical record at KFVP. The decisions these people are able to make include, but are not limited to, authorizing medical treatments/procedures required or recommended for my pet(s), authorizing the financial obligation that is a direct result of the treatment/procedure they authorized, consent or decline any DNR (Do Not Resuscitate) clause or euthanasia. I understand that the people below must be over 18 years old as they are acting on my behalf. I also understand that any costs accrued on my account are payable by me as I am the official owner of my pet(s) listed as patients at KFVP