Completion of this form will be required for continued care at Carbondale Animal Hospital

This form will take approximately 10 minutes to complete.

This form will review our various policies to include:

  • Understanding the appropriate veterinary-client-patient relationship
  • Emergency and urgent care status
  • 24-hour care status
  • Payment agreement
  • Late arrival appointments & missed appointments
  • Return of prescription medications and non-prescription goods
  • Media release

Please read each section below thoroughly and completely.
 

AGREEMENT INFORMATION
Name
The information provided in the agreement will help Carbondale Animal Hospital better serve your needs, along with the needs of your pet(s). Please enter your first and last name(s) as it appears on your account at Carbondale Animal Hospital:
UNDERSTANDING THE VETERINARIAN-CLIENT-PATIENT RELATIONSHIP (VCPR)
  • The Veterinary-Client-Patient relationship (VCPR) is a legal standard set forth by the State of Colorado regulatory board along with the American Veterinary Medical Association and one which Carbondale Animal Hospital has adopted.
  • A valid VCPR is established when the client and patient have appropriate in-person interactions in a timely manner with the veterinarian and veterinary staff. This interaction includes the client coming to the clinic annually for a veterinarian’s examination of the patient, accompanied by recommended follow-up examinations and appropriate diagnostics, based on specific medical need(s) presented.
  • The client may further interact with the veterinarian and the staff by telephone and e-mail. In very rare instances, the veterinarian or veterinary staff may visit the home of the client in order to care for the patient.
  • The veterinarian and staff are responsible for maintaining medical records to document examinations, diagnostics, recommendations, and follow-up care for each patient.
  • Prescription medications cannot be prescribed and specific advice may not be given if the VCPR is not current.
UNDERSTANDING THE VETERINARIAN-CLIENT-PATIENT RELATIONSHIP (VCPR)
  • The Veterinary-Client-Patient relationship (VCPR) is a legal standard set forth by the State of Colorado regulatory board along with the American Veterinary Medical Association and one which Carbondale Animal Hospital has adopted.
  • A valid VCPR is established when the client and patient have appropriate in-person interactions in a timely manner with the veterinarian and veterinary staff. This interaction includes the client coming to the clinic annually for a veterinarian’s examination of the patient, accompanied by recommended follow-up examinations and appropriate diagnostics, based on specific medical need(s) presented.
  • The client may further interact with the veterinarian and the staff by telephone and e-mail. In very rare instances, the veterinarian or veterinary staff may visit the home of the client in order to care for the patient.
  • The veterinarian and staff are responsible for maintaining medical records to document examinations, diagnostics, recommendations, and follow-up care for each patient.
  • Prescription medications cannot be prescribed and specific advice may not be given if the VCPR is not current.

 

EMERGENCY & URGENT CARE STATUS
  • Carbondale Animal Hospital is not an emergency care clinic nor an urgent care facility.
  • We are not available for consultation outside of our regular business hours.
  • During regular hours, our ability to see urgent or emergency cases on a particular day is based on our current case load, along with the availability of our staff.
  • If we have reached our maximum capacity for the day, the staff will advise you to seek care at one of the urgent care or emergency facilities out of respect for our previously scheduled clients and the time limits of our staff.
  • The closest urgent and emergency care facilities are: Valley Emergency Pet Care (VEPC) in Basalt, Willits Veterinary Hospital in Willits and Glenwood Springs, and Animal ER of the Western Slope in Grand Junction.
  • We encourage you to contact one of these facilities for availability prior to arrival at their building.
  • These facilities will share their medical records with Carbondale Animal Hospital after your visit is completed in order to allow us to provide continued care, when necessary.
  • Please be aware that there is often a delay of several days before we receive records, and in some cases, we are never notified of a patient’s visit; as such, it is beneficial for you to to notify Carbondale Animal Hospital if you have had such a visit to one of these facilities so we can follow-up.

EMERGENCY & URGENT CARE STATUS
  • Carbondale Animal Hospital is not an emergency care clinic nor an urgent care facility.
  • We are not available for consultation outside of our regular business hours.
  • During regular hours, our ability to see urgent or emergency cases on a particular day is based on our current case load, along with the availability of our staff.
  • If we have reached our maximum capacity for the day, the staff will advise you to seek care at one of the urgent care or emergency facilities out of respect for our previously scheduled clients and the time limits of our staff.
  • The closest urgent and emergency care facilities are: Valley Emergency Pet Care (VEPC) in Basalt, Willits Veterinary Hospital in Willits and Glenwood Springs, and Animal ER of the Western Slope in Grand Junction.
  • We encourage you to contact one of these facilities for availability prior to arrival at their building.
  • These facilities will share their medical records with Carbondale Animal Hospital after your visit is completed in order to allow us to provide continued care, when necessary.
  • Please be aware that there is often a delay of several days before we receive records, and in some cases, we are never notified of a patient’s visit; as such, it is beneficial for you to to notify Carbondale Animal Hospital if you have had such a visit to one of these facilities so we can follow-up.

 

24-HOUR CARE STATUS
  • Our veterinary clinic is NOT a 24-hour care facility and we do not provide 24-hour monitored care.
  • During the overnight hours from 5:30 pm to 8:00 am, your pet will not be monitored by an individual if there is the unforeseen need for your pet to remain at our clinic overnight.
  • If your pet is deemed to be in a critical condition, we will advise that you transport your pet to a local 24-hour facility.
  • If you do not consent to leaving your pet without overnight observation and you decline transfer to a local 24-hour care facility, you may choose to take your pet home even though it may be against our professional recommendation.
  • Our veterinary clinic is NOT a 24-hour care facility and we do not provide 24-hour monitored care.
  • During the overnight hours from 5:30 pm to 8:00 am, your pet will not be monitored by an individual if there is the unforeseen need for your pet to remain at our clinic overnight.
  • If your pet is deemed to be in a critical condition, we will advise that you transport your pet to a local 24-hour facility.
  • If you do not consent to leaving your pet without overnight observation and you decline transfer to a local 24-hour care facility, you may choose to take your pet home even though it may be against our professional recommendation.
PAYMENT AGREEMENT
  • Payment for services is to be rendered prior to patient discharge from the clinic.
  • Valid payment forms include US currency, VISA, MasterCard, Discover, American Express and Care Credit.
  • Carbondale Animal Hospital requires a valid major credit card to be securely stored for the sole purpose of authorized payments.
  • Funds must be available at the time of service.
  • Failure to rectify unpaid invoices for any reason will incur a 5% fee for every 30 days past due and may result in forwarding the account to a collections agency and/or termination of the veterinarian-client relationship. Any fees incurred as a result of collection attempts are the responsibility of the party in default. Furthermore, ongoing services will not be provided if there is an outstanding balance on the account.
  • Carbondale Animal Hospital will work with pet insurance providers on a case by case basis and is subject to change at any time.
PAYMENT AGREEMENT
  • Payment for services is to be rendered prior to patient discharge from the clinic.
  • Valid payment forms include US currency, VISA, MasterCard, Discover, American Express and Care Credit.
  • Carbondale Animal Hospital requires a valid major credit card to be securely stored for the sole purpose of authorized payments.
  • Funds must be available at the time of service.
  • Failure to rectify unpaid invoices for any reason will incur a 5% fee for every 30 days past due and may result in forwarding the account to a collections agency and/or termination of the veterinarian-client relationship. Any fees incurred as a result of collection attempts are the responsibility of the party in default. Furthermore, ongoing services will not be provided if there is an outstanding balance on the account.
  • Carbondale Animal Hospital will work with pet insurance providers on a case by case basis and is subject to change at any time.
LATE ARRIVAL & MISSED APPOINTMENT POLICY
  • With the heightened demand for veterinary services, every appointment slot is valuable to us and the pets in our care. Missed appointments are times when a sick pet could have received medical care, and late arrivals can have a domino effect for the remaining clients scheduled for the day.
  • MISSED APPOINTMENT: If a client fails to appear for their previously scheduled appointment, we may require a deposit up to or equal to the expected cost of services for every future appointment. If the client and patient fail to appear for any subsequent pre-paid appointment or surgery, the client will forfeit the full pre-payment. At any time, Carbondale Animal Hospital may rescind offers for care, effectively terminating the VCPR.
  • LATE ARRIVAL: Late arrivals for appointments of greater than 5 minutes may cause the veterinary staff to arrive late for the subsequently scheduled appointments on a given day. The staff already has the challenge of managing unexpected emergencies and medically complex appointments that may run beyond the time allotted on the schedule, so additional delays need to be avoided. If you know you will arrive late, please call the clinic on your way so we can all plan accordingly.
  • When a late arrival occurs, we will either offer to see your pet, offer to have your pet admitted for a “drop off” (which requires you to leave your pet in our care so we may attend to them when availability permits and you or a designated party would return prior to the close of business to retrieve your pet), or we will offer to reschedule your appointment. The option offered will be up to the veterinary staff based on the flow of the appointment schedule on the given day. Repeatedly late arrivals may result in termination of the client from Carbondale Animal Hospital for all future care.
  • We realize that our clients are occasionally kept waiting beyond their scheduled time. We truly strive to prevent this from occurring, but between late arrivals, unforeseeable complex cases, concurrent emergencies and/or staffing shortages, we cannot always guarantee the start time for an appointment. If we are taking longer to start your appointment than your schedule allows, please notify the receptionist and we will offer to admit your pet for “drop off” or reschedule your appointment at your convenience and our earliest availability.
  • We understand that emergencies arise and schedules change, so please contact us as soon as possible if you are unable to appear for your already scheduled appointment or surgery.
  • Many of the surgical procedures and advanced diagnostic services provided by Carbondale Animal Hospital require appointments that span several hours and require specific staffing and scheduling. Therefore, Carbondale Animal Hospital requires a deposit of $200 to schedule any surgical procedure or advanced diagnostic service. In the event the appointment is cancelled or changed within 48 hours of the scheduled event, Carbondale Animal Hospital may retain the deposit in its entirety. Future appointments of this nature will require a new $200 deposit. Upon service, the $200 deposit will be applied to the final invoice.
  • With the heightened demand for veterinary services, every appointment slot is valuable to us and the pets in our care. Missed appointments are times when a sick pet could have received medical care, and late arrivals can have a domino effect for the remaining clients scheduled for the day.
  • MISSED APPOINTMENT: If a client fails to appear for their previously scheduled appointment, we may require a deposit up to or equal to the expected cost of services for every future appointment. If the client and patient fail to appear for any subsequent pre-paid appointment or surgery, the client will forfeit the full pre-payment. At any time, Carbondale Animal Hospital may rescind offers for care, effectively terminating the VCPR.
  • LATE ARRIVAL: Late arrivals for appointments of greater than 5 minutes may cause the veterinary staff to arrive late for the subsequently scheduled appointments on a given day. The staff already has the challenge of managing unexpected emergencies and medically complex appointments that may run beyond the time allotted on the schedule, so additional delays need to be avoided. If you know you will arrive late, please call the clinic on your way so we can all plan accordingly.
  • When a late arrival occurs, we will either offer to see your pet, offer to have your pet admitted for a “drop off” (which requires you to leave your pet in our care so we may attend to them when availability permits and you or a designated party would return prior to the close of business to retrieve your pet), or we will offer to reschedule your appointment. The option offered will be up to the veterinary staff based on the flow of the appointment schedule on the given day. Repeatedly late arrivals may result in termination of the client from Carbondale Animal Hospital for all future care.
  • We realize that our clients are occasionally kept waiting beyond their scheduled time. We truly strive to prevent this from occurring, but between late arrivals, unforeseeable complex cases, concurrent emergencies and/or staffing shortages, we cannot always guarantee the start time for an appointment. If we are taking longer to start your appointment than your schedule allows, please notify the receptionist and we will offer to admit your pet for “drop off” or reschedule your appointment at your convenience and our earliest availability.
  • We understand that emergencies arise and schedules change, so please contact us as soon as possible if you are unable to appear for your already scheduled appointment or surgery.
  • Many of the surgical procedures and advanced diagnostic services provided by Carbondale Animal Hospital require appointments that span several hours and require specific staffing and scheduling. Therefore, Carbondale Animal Hospital requires a deposit of $200 to schedule any surgical procedure or advanced diagnostic service. In the event the appointment is cancelled or changed within 48 hours of the scheduled event, Carbondale Animal Hospital may retain the deposit in its entirety. Future appointments of this nature will require a new $200 deposit. Upon service, the $200 deposit will be applied to the final invoice.
RETURN OF PRESCRIPTION MEDICATION AND GOODS
  • Carbondale Animal Hospital adheres to state and federal guidelines regarding the terms of sale of prescription medication. Any prescription medication that leaves our facility is ineligible for return. Prescription medication that is no longer needed may be donated to the clinic for use by another patient in need. We also encourage clients to consider donating pet-related items of any sort to our local animal shelter, Colorado Animal Rescue (C.A.R.E.).
  • Items that are unopened, unused, and determined eligible for return by an authorized CAH employee may incur a 25% restocking fee.
RETURN OF PRESCRIPTION MEDICATION AND GOODS
  • Carbondale Animal Hospital adheres to state and federal guidelines regarding the terms of sale of prescription medication. Any prescription medication that leaves our facility is ineligible for return. Prescription medication that is no longer needed may be donated to the clinic for use by another patient in need. We also encourage clients to consider donating pet-related items of any sort to our local animal shelter, Colorado Animal Rescue (C.A.R.E.).
  • Items that are unopened, unused, and determined eligible for return by an authorized CAH employee may incur a 25% restocking fee.
MEDIA RELEASE
  • Carbondale Animal Hospital may photograph and/or video record my pet(s) and retain the media indefinitely.
  • Carbondale Animal Hospital may post images and/or video recordings of my pet(s) to the clinic website, Facebook, Instagram, and/or other social media platforms in good faith and without credit listed.
  • Carbondale Animal Hospital may use images and videos for marketing and/or educational purposes.
UNDERSTANDING OF CURRENT AGREEMENT
  • I acknowledge that I / we have completely read and fully understand all of the above information and agree to be bound thereby.
  • I / we understand that failure to comply with the terms herein may result in refusal to care for my pet(s) at Carbondale Animal Hospital and its current and future affiliates.
  • I understand that I/we must demonstrate compliance with the terms herein through the signature authorization series of this form OR demonstrate acceptance by receiving services at Carbondale Animal Hospital without documented decline.
UNDERSTANDING OF CURRENT AGREEMENT
  • I acknowledge that I / we have completely read and fully understand all of the above information and agree to be bound thereby.
  • I / we understand that failure to comply with the terms herein may result in refusal to care for my pet(s) at Carbondale Animal Hospital and its current and future affiliates.
  • I understand that I/we must demonstrate compliance with the terms herein through the signature authorization series of this form OR demonstrate acceptance by receiving services at Carbondale Animal Hospital without documented decline.
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Thank you for your cooperation in helping us to maintain our commitment to excellence, thorough communication, and transparency in our practices. Our relationship is of the upmost importance.