New Clients

Welcome!

Thank you for considering our hospital as your pet’s provider of veterinary services. We are dedicated to maintaining the health of your pet and look forward to many future years together.

Please complete this form as fully as possible prior to your first appointment which will help expedite the registration process and give us valuable insight in providing optimal care for your pet(s). The required sections have a red * asterisk. After you submit your registration, please email all previous records to: hilltopvet@live.com

New Client Registration

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Pet's Name *

Age *

Species *

Sex *

Breed *

Color *

PET #2 NAME *

Age #2 *

SPECIES #2 *

SEX #2 *

BREED #2 *

Color #2 *

REASON FOR VISIT (Please let us know if you already have a scheduled appointment): *

How did you hear about us? Who referred you? *

PLEASE UPLOAD ANY PET RECORDS THAT YOU MAY HAVE. *

Max file size: 20MB

DO YOU GIVE CONSENT FOR STAFF TO TAKE YOUR ANIMAL'S PICTURE AND POSSIBLY BE USED FOR SOCIAL MEIDA? *

I understand that there is a $50.00 deposit due per pet to be paid at time of scheduling an appointment. This deposit will be applied to the patient's first visit, but it is nonrefundable if the appointment fails to be kept. I understand that if I cancel my appointment within 24 hours of my appointment time there will be a cancellation fee of $25 (per pet scheduled) added to my account. I understand that if I fail to call or show up for my scheduled appointment there will be a $50 no show fee (per pet scheduled) added to my account. Hilltop Veterinary Clinic does not have a billing policy and that payment is due at time of services rendered. I understand that I am responsible for the payment of this account. If a payment has not been received after 90 days, any remaining balance will be sent to collections and is subject to being reported to a consumer credit agency. I will also be held accountable for any fees incurred in the collection of this account including, but not limited to court costs, filing fees, collection fees, prescription fees, and attorney not to exceed 33.3%. I understand that if my pet is not picked up within ten (10) days from the specified date of release, that my animal will be considered abandoned and will become the property of Hilltop Veterinary Clinic. I also understand that this does not relieve me of the responsibility for all costs incurred, including additional boarding and collection fees. I understand that there is a $30.00 fee on all returned checks.

By submitting this form, I affirm that I have read and fully understand my rights, and responsibilities.

Submit

Below you will find contact information for our Veterinary Clinic in Virginia Beach. Please contact us to make an appointment!

Hilltop Veterinary Clinic
1801 Laskin Rd
Virginia Beach, VA 23454
757-425-2011
hilltopvet@live.com

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