Pet Owner Name *

First

Last

Customer type *

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Pet Name *

Pet Breed *

Pet Age/Date of Birth *

Pet Gender *

Male
Male Neutered
Female
Female Spayed

Name of Your Current Veterinary Hospital *

Current Veterinary Hospital Phone Number *

Preferred appointment location?

Monday - Bridgewater Veterinary Hospital, Bridgewater NJ
Tuesday - South Branch Veterinary Services, South Lebanon NJ
Wednesday - Bridgewater Veterinary Hospital, Bridgewater NJ
Thursday AM - Stockton Veterinary Hospital, Stockton NJ
Thursday PM - Belle Mead Animal Hospital, Hillsborough NJ

*PVS operates 8-6 Monday-Thursday

Pet diagnosis or any information you would like us to know.

Diagnosis: Cytology/Biopsy Results

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Recent 6 Month Medical History

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Blood Work or Imaging

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PVS appointment agreement

Private Veterinary Specialties' goal is to provide excellent care to each patient in a timely manner. Appointment times are reserved exclusively for you and your pet. Late arrivals make it difficult for us to address the needs of your pet, missed appointments prevent us from helping other pets in need of prompt care.

1. Prepayment Required
We require prepayment for the initial consultation. This fee holds your appointment time and helps reduce no-shows. It will be applied to your first visit as long as you arrive on time and the appointment is not rescheduled with <24hrs notice.

2. Late Arrival Policy
Please arrive a few minutes early for check-in.
If you are 10 minutes or more late, we may need to cancel your appointment or reschedule.
If this happens, $100 of the prepaid fee will be forfeited for first consultations. Recheck visits will have a missed appointment fee applied of $100.

3. Cancellation & Rescheduling
If you need to cancel or reschedule, please notify us at least 24 hours in advance.

If you need to cancel or reschedule, please notify us at least 24 hours in advance. Cancellations made 24 hours or more prior to your appointment may be rescheduled without any fee. Cancellations made less than 24 hours prior or not showing up will have $100 of the pre-paid fee forfeited, with the remainder of the balance either refunded or applied to your next visit.
Cancellations made less than 24 hours before, or not showing up:
$100 of the pre-paid fee will be forfeited, the remainder is either refunded or applied to your next visit.

4. No-Show Definition
A “no-show” includes:

Not arriving for your appointment
Canceling with less than 24 hours notice
Arriving 10 minutes or more late.

In these cases, $100 of the pre-paid fee will be forfeited, the remainder is either refunded or applied to your next visit.

5. Emergencies
We understand that life happens. If a genuine emergency prevents you from attending, please contact us as soon as possible. We will always do our best to work with you.

6. Agreement
By booking a new client appointment and submitting pre-payment, you acknowledge that you have read and agree to this policy.

Client Acknowledgment – Appointment Policy

Pre-Payment Agreement

We require pre-payment for the initial consultation. This policy helps reduce no-shows. Payment will be applied to your first visit as long as you arrive on time and the appointment is not rescheduled with less than 24 hours notice.

Client Acknowledgment *

I understand that my first appointment requires a pre-payment to reserve the time slot.

Late Arrival Policy

Please arrive a few minutes early for check-in. If you are 10 minutes or more late, we may need to cancel your appointment or reschedule. If this occurs, $100 of the pre-paid first consultation will be forfeited. Recheck visits likewise have a missed appointment fee applied of $100 for late or last minute cancellations.

Client Acknowledgment (copy) *

I understand that if I arrive 10 minutes or more late, my appointment may be cancelled and $100 of the pre-paid fee will be forfeited.

Cancellation and Rescheduling

If you need to cancel or reschedule, please notify us at least 24 hours in advance. Cancellations made 24 hours or more prior to you appointment may be rescheduled without any fee. Cancellations made less than 24 hours prior or not showing up will have $100 of the pre-paid fee forfeited, with the remainder either refunded or applied to your next visit.

Client Acknowledgment (copy) (copy) *

I understand that cancellations must be made at least 24 hours in advance. Cancellations made with less notice, or missed appointments (“no-shows”), will result in $100 forfeiture of the pre-paid fee.

Emergencies

We understand that life happens, and that emergencies may arise. If a genuine emergency prevents you from attending, please contact us as soon as possible. We will always do our best to work with you.

Client Acknowledgment (copy) (copy) (copy) *

I understand that emergencies may be considered on a case-by-case basis at the clinic’s discretion. Traffic is not considered an emergency.

Agreement

By booking a new client appointment and submitting pre-payment, you acknowledge that you have read and agreed to this policy.

Client Acknowledgment (copy) (copy) (copy) (copy) *

By booking this appointment, I agree to the terms of the cancellation, late arrival, and no-show policy.

Signature *

Clear Signature

Date *

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PVS appointment agreement

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