Client Contact

We know your pet’s health is important and we thank you for trusting us to care for them. To help us provide the best care for your pet, please take a few minutes to fill out this form completely. Thank you.

Primary Caregiver First and Last name:(Required)

Preferred Pronouns:

Secondary Caregiver First and Last Name:

Preferred Pronouns:

Address(Required)

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

County:(Required)

Primary Email:(Required)

Your email address will be used strictly for internal purposes for communication between Finan Animal Hospital and authorized parties. We will email you about your pet’s appointments, vaccination reminders, updated policies, as well inclement weather updates, and estimates for surgical and medical services.

Secondary Email:

Primary Phone Number:(Required)

Secondary Phone Number:

How did you hear about our veterinary hospital?(Required)

Please list any other persons over the age of 18 that are authorized to bring your pet in for care and to make medical decisions if you or the secondary contact on your account are not able to(ie; pet sitter, boarding facility, family member, neighbor, etc). Please note payment is due at time of services rendered:

Client Expectations

At Finan Animal Hospital, we are on a mission to improve the lives of our patients, clients and employees. One of the ways we aim to do this is through a focus on providing a safe and supportive workplace – doing everything we can to maintain physical and psychological safety for everyone who interacts with our business. Our core values include kindness & compassion, responsibility, meaningful interactions, inclusivity, and community. We strive to behave in alignment with these values in every interaction. We encourage individuals we work with to provide feedback to help us continuously improve over time. This is what our clients can expect from us. In turn, we do have expectations of our clients to maintain a healthy working relationship and to protect our team’s mental health and ability to provide a psychologically safe environment for everyone:

Respectful communication with us and other individuals visiting the clinic, including verbal, non-verbal or digitally (including on social media)
Acting in accordance with our core policies – this includes abiding by our physical and psychological health and safety, accessibility, and inclusivity policies.
Refraining from disparaging remarks that could be considered harassment - this includes emotional blackmail, swearing, inappropriate name calling or derogatory remarks or gestures.
Adherence to our payment policies.
That feedback is given in a respectful, constructive way via the available avenues.

By signing below you acknowledge the above policies and agree to pay for all services at time rendered.

Primary Signature:(Required)

Primary Printed Name:(Required)

Date(Required)

Rabies Immunization Policy

Rabies vaccination of ALL cats and dogs is required by Illinois law. This applies to all pets, including “indoor only” cats.

New patients must provide proof of current rabies immunization prior to first visit. If no proof can be provided, your pet will receive a rabies vaccination at their first visit.
By law, a physical examination by a veterinarian must take place at the time of rabies immunization. Rabies immunizations cannot be administered by a veterinary technician or during a technician office visit. Please note this is Illinois state law and is non-negotiable.
Rabies immunizations will thereafter be updated at the time of a pet’s annual examination.
Clients who refuse rabies immunization for their pets or do not return for annual immunizations will be discharged from the practice for failure to comply with policy practice and state law.

Thank you for your understanding and cooperation.

Client/Owner Signature(Required)

Client/Owner Name(Required)

Date(Required)

Prescription Refill Policy

We require 24 hrs notice for routine refills.
We require 48 hrs notice for controlled substance refills.
You may request refills from the clinic or from our online pharmacy (via our website).
Any prescription requests for online pharmacies outside of Finan Animal Hospital require a written prescription which you must pick up here at the clinic.
For prescriptions requested to human pharmacies(Costco, Walgreens, CVS), Finan Animal Hospital will call these in for you.
For all prescriptions outside of Finan Animal Hospital, you will be required to sign a prescription waiver before the prescription can be released to you.
If you request a prescription for same day pick up, a rush fee of $10.00 will be applied to your invoice. We require 2 hrs filling time for these requests. Controlled substances cannot be filled on same day requests.

Client Signature:(Required)

Client Name Printed:(Required)

Date(Required)

Financial Policies

Financial Policies of Finan Animal Hospital At Finan Animal Hospital we strive to provide premium veterinary care for our patients. We can continue to offer such care and maintain a well-equipped, properly staffed facility only if we receive prompt payment for our services and products.

Having a pet is a special privilege, not a right. With that privilege comes the financial responsibility of providing quality preventative & medical care for your pet. With that in mind, please read the following financial policy:

We require a credit card on file. Our payment processing company (Payjunction) hosts your credit card information and has several security requirements to protect credit card data and complies with the Payment Card Industry Data Security Standards (PCI-DSS). We can only see the last 4 digits of your credit card in our system. Our employees never have access to your card information.
If you do not feel comfortable with keeping a credit card on file, as an alternative, you will be asked to leave an $87.00 deposit on your account. This is shown as a credit on your account and is not applied to any services or appointments outside of a missed or canceled appointment. If you miss or cancel your appointment with less than 24 hrs notice, the credit will be forfeited. You will need to provide another deposit before future appointments can be scheduled.
Full payment is due when services are rendered or pharmacy items are dispensed. We accept Cash, Care Credit, and all major credit cards. We do NOT accept checks.
If you are unable to pay your bill, you may apply for Care Credit. Care Credit is a medical credit company which provides full payment for veterinary care for eligible clients and accepts monthly payments until the balance is paid in full. We do NOT have payment plans.
Our nurses or doctors will provide you with an estimated treatment plan prior to performing any services. Only persons over the age of 18 may sign treatment plans.
If you are unable to pay for all recommended services and inventory items, the doctor can help you decide which are most important for your pet that day & which can wait until you are able to provide payment.
If you are concerned about your ability to financially care for your pet, we strongly recommend you consider a pet insurance policy.
A booking fee of $85.00 is due at the time of scheduling surgical, dental, and ultrasound procedures. It is non-refundable if canceled with less than 24 hrs notice or you do not show for your appointment.
If you do not pay your invoice at time of services rendered, you and your pet(s) may be dismissed from Finan Animal Hospital at the discretion of management.

Thank you for your understanding and cooperation.

Client/Owner Signature(Required)

Client/Owner Name(Required)

Date(Required)

Cancellation Policy

Finan Animal Hospital is a premier veterinary clinic, providing 30-45 minute appointments tailored to each individual patient. Each time a patient misses an appointment without providing proper notice, another patient is prevented from receiving care.

In order to continue providing our patients with this high standard of care, we have implemented the following missed appointment/cancellation policy.

Cancellation Policy:

All requests for cancellation and/or rescheduling must be made at least 24 hours in advance of the scheduled appointment.

If you have made a same day appointment, you acknowledge your commitment to come in for that scheduled time. If you cancel your same day appointment, this will be considered less than 24 hrs notice.

If you are late 15 mins or more for your scheduled appointment, it will be considered a missed appointment and will be rescheduled.

1st time: We will gladly give you the courtesy of waiving the no-show, late or cancellation/reschedule fee as we understand that emergencies do occur.

2nd time: You will be charged the cost of the appointment you are missing if you fail to cancel/reschedule 24 hours prior to your scheduled appointment. We will charge the credit card on file.

3rd time: If a third no show, late or cancellation/reschedule without 24-hour notice should occur you will be required to prepay for all future appointments with a non-refundable booking fee or you and your pet(s) may be dismissed from Finan Animal Hospital at the discretion of management.

Thank you for your understanding and cooperation as we strive to best serve the needs of all our patients.

Client/Owner Signature(Required)

Client/Owner Name(Required)

Date(Required)

Patient Dismissal Policy

The veterinarian-client-patient relationship (VCPR) is the basis for interaction among veterinarians, their clients, and their patients and is critical to the health of animals.

Illinois law requires a current VCPR in order for us to provide continued care for your pet. This means each pet must be examined by a veterinarian once a year.

No person may practice veterinary medicine in the State except within the context of a veterinarian-client-patient relationship. A veterinarian-client-patient relationship cannot be established solely by telephonic or other electronic means.

Although the following list is not exhaustive, we may choose to terminate your VCPR under the following circumstances:

Lapse in VCPR: Pet owner understands that Veterinarian-Client-Patient relationship will lapse if their pet has not been examinedby a veterinarian at our hospital within the last 12 months.

Treatment nonadherence: The pet owner does not or will not follow the treatment plan or the terms of illness management, or discontinues medication or therapy regimens prior to completion.

Follow-up noncompliance: The client repeatedly cancels follow-up visits or fails to keep scheduled appointments with our doctors or nurses.

Office policy nonadherence: The client fails to observe office policies, such as those implemented for prescription refills or appointment cancellations.

Verbal abuse or violence: The client, a family member, or a third-party caregiver is rude, uses disparaging or demeaning language, or harasses office personnel or other patients, visitors, or vendors; exhibits violent or irrational behavior; makes threats; or uses anger to jeopardize the safety and well-being of any person or patient present in the office.

Display of firearms or weapons: The client, a family member, or a third-party caregiver wields a firearm or weapon on the premises.

Inappropriate or criminal conduct: The client exhibits inappropriate sexual behavior toward providers or staff or participates in drug diversion, theft, or other criminal conduct involving the practice.

Nonpayment: The client does not adhere to the financial policy. All payment is due at time of service.

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Client Contact

Client Expectations

Rabies Immunization Policy

Prescription Refill Policy

Financial Policies

Cancellation Policy

Patient Dismissal Policy

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