New Client Registration Form

Fill out the form below and we'll get back to you as soon as possible.

Legal Name:

Physical Address:

Mailing Address:

Cell Phone:

Home Phone:

Business Phone:

Email Address:

Client Health Consent Form

NOTE TO CLIENT:

We want to make sure you fully understand the services we offer, the costs involved, and how we handle your personal information and that of your animals. If you have any questions about this form, please feel free to ask.

CONSENT FOR TREATMENT:

By signing below, I give my consent to receive treatments recommended by Nomad Veterinary Services or its authorized representatives.

CONSENT FOR PERSONAL INFORMATION:

I understand that Nomad Veterinary Services will collect personal information such as my home address, mailing address, phone number, email address, and other identifying details in order to provide veterinary services. Nomad will not share this information unless directed to do so by one of the representatives on file or via the court system of Alberta.

I understand the Nomad Veterinary Services Privacy Policy, which explains how my information will be used, stored, and protected. I understand my right to review my personal information and ask questions about how it is handled. All my questions regarding the Privacy Policy have been answered to my satisfaction.

COMMUNICATION PREFERENCES:

I understand that by checking the boxes below, I choose to receive the following:

Notifications when it is time to review or update the goods or services I need:

Newsletters and informational mailings from Nomad Veterinary Services:

Newsletters, informational mailings, and promotional offers from other organizations that Nomad Veterinary Services thinks may be of interest to me:

AGREEMENT:

By signing below, I agree to the collection, use, and disclosure of my personal information as outlined above and in the Nomad Veterinary Services Privacy Policy. I also consent to receive treatments recommended by Nomad Veterinary Services or its authorized representatives.

E-Signature:

You must add your signature to submit.

Signature required.

Please select and agree to the terms of all services you are interested in below.

Bovine Services

Bovine Payment Terms:

All bovine services are due within 90 days from the date the invoice is issued.

Any balances remaining unpaid beyond 90 days will incur a monthly interest charge of 2%, which will continue to accrue until the balance is paid in full.

Accounts with an outstanding balance beyond 90 days, where no ongoing payments have been made and our attempts to contact the client have gone unanswered for several consecutive weeks, may be referred to a collections agency. We understand that unexpected circumstances can arise, and we’re here to help. If you’re experiencing difficulity making a payment, please contact us as soon as possible to discuss payment options before your account reaches this stage.

AGREEMENT:

By signing below, I confirm that I have read, understood, and agree to the payment terms outlined above.

E-Signature:

You must add your signature to submit.

Signature required.

Horse, Small Animal, and Ruminant Services

Horse, Small Animal, and Ruminant Payment Terms:

I understand that all fees for veterinary services are due at the time of service and can be paid by cash, debit, credit card, or e-transfer.

To secure an appointment, a valid credit card must be provided and kept on file. If no credit card is available, a deposit is required in advance via e-transfer. This deposit must be either $126 or 50% of the estimated total, whichever is greater.

If payment is made via e-transfer, the remaining balance must be paid in full by the last day of the month in which the appointment occurred. If payment has not been received by that date, the credit card on file will be charged for the outstanding balance.

Interest of 2% per month (24% annually) will be applied to any overdue accounts.

Accounts with an outstanding balance beyond 90 days, where no payments have been made and our attempts to contact the client have gone unanswered for several consecutive weeks, may be referred to a collections agency. We understand that unexpected circumstances can arise, and we’re here to help. If you’re experiencing difficulity making a payment, please contact us as soon as possible to discuss payment options before your account reaches this stage.

AGREEMENT:

By signing below, you authorize Nomad Veterinary Services to charge your credit card for any outstanding balances in accordance with this policy.

E-Signature:

You must add your signature and credit card to submit.

Signature required.

No card registered.

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