New Client Forms | Honey Creek Vet Hospital in Conyers, GA

Welcome, New Clients!

Thank you for considering Honey Creek Veterinary Hospital for your pet’s needs. Please fill out our new client/patient registration form in entirety to ensure we can provide you and your pet with the best possible care.

Owner Information

Owners Name (18yrs+)(Required)

Phone(Required)

Email(Required)

Employer

Occupation

Spouse/Partner

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Drivers License # (STATE Included)(Required)

How did you hear about us? *

Please let us know who we may thank for referring you:

ex: John Smith (not just dad or cousin)

Pet Information

Pet's name coming for appointment(Required)

Picture of you pet

Accepted file types: jpg, jpeg, png, gif.

Breed & Color(Required)

Species

Birthdate/Age

Other(Required)

Sex(Required)

Male

Female

Spayed/Neutered(Required)

Yes

Do we have permission to use your pets image for Social Media and/or learning purposes?(Required)

Yes

Date & Time of Existing Scheduled Appt. (If you don't have an appt yet, please call the office to request one.)

Date(Required)

Time

Primary Reason For Visit:(Required)

Please list any additional pets that you may have:

Previous Records/ Vaccine History

Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 10 MB.

Previous Records/ Vaccine History

Drop files here or

Accepted file types: jpg, gif, png, Max. file size: 10 MB.

NO SHOW AND CANCELLATION POLICY

Cancellation of an Appointment

In order to be respectful of the medical needs of our community, please be courteous and call promptly if you are unable to attend an appointment. This time will be reallocated to someone who is in urgent need of treatment. This is how we can best serve the needs of our community. If it is necessary to cancel your scheduled appointment, we ask that you notify us as soon as possible. Appointments are in high demand, and your early cancellation will give another patient the possibility to have access to timely medical care.

How to Cancel Your Appointment

To cancel appointments, please call or text (770) 483-7225. If you do not reach the receptionist, you may leave a detailed message on the voice mail or text message.

You may also request to cancel your appointment through our PetDesk Portal.

No Show Policy

A “no show” is someone who misses an appointment without contacting us prior to your appointment time. No-shows inconvenience those individuals who need access to medical care in a timely manner. A failure to be present at the time of a scheduled appointment will be recorded in the patient's chart as a “no show”. Your account will be flagged and a $25 nonrefundable deposit will be required to schedule future appointments. This deposit will be utilized for the appointment being made. This fee will need to be paid in full before scheduling any further appointments. Three “no shows” in a 12-month period of time may result in discharge of the practice.

Financial Policy

Thank you for choosing Honey Creek Veterinary Hospital. Our primary mission is to deliver the best and most comprehensive veterinary care available for your pet. An important part of the mission is making the cost of optimal care as easy and manageable for our clients as possible by offering several payment options. Honey Creek Veterinary Hospital requires payment in full at the end of your pet’s examination and/or at the time of discharge. Honey Creek Veterinary Hospital does not offer any type of payment plan.

Payment Options: Cash, Check, Debit, Visa, Master Card, American Express, or Discover, ScratchPay, and Care Credit (A Third Party Medical Credit Card)

For some treatment or hospitalization, a deposit may be required. Healthcare plans requiring comprehensive care of more than $500 will require a 50% deposit to begin your pet’s treatment.

Additional Policy Information:

Honey Creek Veterinary Hospital charges for any returned checks.

For clients with Pet Insurance we are happy to provide the necessary documentation to submit a claim to your insurance carrier.

We will submit any Insurance claims for policy holders of Trupanion Pet Insurance.

Any balance left unpaid will incur an 8% interest charge after 30 days.

Client agrees to reimburse Honey Creek Veterinary Hospital for all costs and expenses (including, without limitation, reasonable legal fees and court costs) incurred by Honey Creek Veterinary Hospital in enforcing collection of any monies due under this arrangement. Further, Honey Creek Veterinary Hospital reserves the right to enforce a thirty (30%) percent upcharge on all invoices sent to collections.

Anyone sent in your place is authorized to approve treatment deemed necessary.

If you have any questions, please do not hesitate to ask. We are here to provide the best veterinary care available for your pet.

By signing below, you agree to the foregoing terms of payment.

Signed Name *(Required)

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