Dr. Gary L. Wood, DVM, ACVIM (Cardiology) Phone: 503-246

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Dr. Gary L. Wood, DVM, ACVIM (Cardiology)

Phone: 503-246-9689; Fax: 503-246-6407 www.heartvet.com; info@heartvet.com

Cardiology Northwest Policy Form

These policies are based on our mission of

“Absolute Love for Pets.”

Your first visit to Cardiology Northwest includes the following benefits:

Initial consultation for:

Establishment of medical history and doctor examination

Review of records and previous diagnostic testing

Recommendations for additional diagnostic tests

Estimate of cost for recommended diagnostic testing

Follow up consultation, generally the same day, for:

Interpretation of all diagnostic tests performed

Medication and treatment recommendations

Recheck recommendations

A referral letter will be sent to your regular veterinarian and any specialists that are currently treating your pet, regarding the cardiac findings. A phone consultation with your pet’s doctor will be provided if needed.

Approvals for prescriptions until your pet’s next recheck appointment.

If you have been referred by a veterinarian, we ask that you use our hospital only for services related to the cardiac referral. For all other routine veterinary care, please consult your regular veterinarian.

In order to best serve your pet’s changing needs, we require regular recheck examinations for prescription approvals. These rechecks are usually scheduled every two to six months, or up to yearly, depending on the severity of the problem. Recheck examinations are generally less expensive than the initial visit.

We cannot accept returned prescriptions for a refund once they have left our hospital, but we will be happy to take them as a donation to use in cases where the owners cannot afford care.

We attempt to provide estimates for all services before performing them. Sometimes in a hospitalization or emergency it is difficult to give an accurate estimate. Please tell us if you have specific cost concerns. We accept cash, checks (processed with

TeleCheck®), debit cards, VISA, Master Card, Discover Card, American Express, and Care Credit.

Payment is due in full on day of services rendered.

We reserve the right to collect a $50 security deposit in instances of multiple or short notice cancellations. Appointments must be modified a minimum of 48 hours prior to your appointment start time to avoid forfeiting this deposit.

Cardiology Northwest may publish photos of me and/or my pet for educational and promotional purposes including Facebook, the business website, and brochures. Check to decline □

If you have an emergency, please call us at 503-246-9689, or your regular veterinarian. If it is an after-hours emergency here is a list of the emergency clinics in the area:

VCA Northwest Veterinary Specialists (503-656-3999)

Tanasbourne Veterinary Emergency (503-629-5800)

Emergency Veterinary Clinic of Tualatin (503-691-7922)

VCA Southeast Portland Animal Hospital (503-255-8139)

Dove Lewis Emergency Animal Hospital (503-228-7281)

Columbia River Veterinary Specialists (360-694-3007)

If none of these are convenient for you please contact your local veterinary office for emergency services in your area.

I have read and understand the above policies and agree to the terms and conditions stated therein.

Client Name ______________________________________________________

Client Signature ________________________________________________________ Date __________________

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