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8300 Quinault Drive NE Suite A, Lacey, WA 98516

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Initial Agreement Form

Please read below and sign each statement:

1. Initial Appointments

A. All initial appointments must fill out a “Patient history form” found on our website within the “online forms” tab. Please click the first link, “New Client forms” and fill out/submit online. You may also fill these out on paper but they must be completed and received by us by Thursday the week BEFORE your appointment to allow for the doctors to adequately review the forms. If forms are not submitted on Thursday before 12:00pm noon, your appointment will be cancelled. We will obtain medical records from your primary veterinarian for the doctors to thoroughly review before each visit. *In July 2022 our policy changed ANY future Initial appointment must complete ALL forms PRIOR to being scheduled*

2. Appointment Times

A. Due to high demand in appointments, we have a 15-minute late policy for initial examinations and a 10-minute late policy for recheck appointments. Please call to reschedule if you are unable to make the appointment within these time periods.
B. Due to high demand in appointments, we have implemented a cancellation fee of $100 and the next examination must be paid for prior to the following appointment. Cancellation of appointments must be made 48 business hours prior to this appointment or the cancelation fee will be implemented.
C. Scheduling for procedures like intradermal allergy testing, video otoscopy, CO2 laser, etc. will require a non-refundable deposit of $500.
D. Due to high demand in appointments, we are unable to see same-day appointments unless it is an emergency. We have an emergency fee of $250 and will schedule your pet permitting our schedule at the discretion of the practice manager.

3. Examinations / Medications

A. Dermatology Clinic for Animals specializes in skin and ear conditions only. If there are additional medical problems that need to be addressed, please do so with your primary veterinarian or additional specialty veterinarian.
B. All initial appointments will take a minimum of 1-2 hours and rechecks will take a minimum of 30-60 minutes. Please note that it will take a minimum of this time to complete each examination, to come up with a treatment plan, and to fill all appropriate medications.
C. If your pet has been aggressive towards humans or animals, we ask that you please let us know PRIOR to your appointment and prior to entering our building. Your pet will be muzzled and we will treat them with care and the utmost respect. If this is not an option then we will not be able to examine your pet and provide adequate treatment(s).
D. All fees are due at the time of service. We accept cash, VISA, Mastercard, and Discover. We DO NOT accept American Express. We do not have payment plans, however, we do accept CareCredit.
E. I accept financial responsibility for my pet and understand that payment is due, in full, at the time of examination. I will be provided with an estimate to sign prior to payment (if requested).
F. Medication refills may take 2-3 business days, our doctors must have the benefit of reviewing your pets medical record before refilling medications. It is best to calculate in advance when you may need a refill on medications. Please allow us 7-14 days to refill and formulate allergens (dependent upon product availability).

4. Release Statement

A. Please sign below if you allow for the doctors to obtain photographs of your pet to document treatment progress and to assist in teaching and lecture materials. Your name and your pet’s name will not be used in any of these materials. If you DO NOT consent then all photographs will remain within the medical record and will not be used for any publication or lecture materials.
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5. By signing below you agree for us to release records to your primary veterinary care team, any specialty referral centers, and insurance agencies.

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6. By signing below, you hereby acknowledge that you understand the policies at Dermatology Clinic for Animals as listed above.

Thank you for helping us continue to offer exceptional care for your pet.
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