Feline Healthy Paws Club Annual Enrollment Form

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Feline Healthy Paws Club Annual Enrollment Form
Client:_____________________________ Client ID:___________________ Enrollment Date:_______________________
Pet Name:______________________________________
Patient ID:___________________________________
Services Provided
Essential
Optimal
*
*
Unlimited Exams
Health Check Profile & Screenings
*
*
Bloodwork - Infections, Anemia, Leukemia, Platelet Count
*
*
Diabetes
*
*
Kidney, Liver and Urinary Tract Diseases
*
Thyroid
Doctor Recommended & Lifestyle Vaccines
*
*
Rabies, Feline Leukemia, FVRCP
*
*
Others specific to your pet's lifestyle
*
*
Intestinal Parasite Screen
*
*
Heartworm Test
*
*
Deworming (2 per year)
*
*
Unlimited Nail Trims
*
Professional Dental Cleaning, Scaling & Polishing
Discount on All Other Services & Products
5%
10%
$19.95/month
$19.95/month
Revolution - Flea, ear mite and heartworm prevention (Optional add)
$240
$360
$19.95/month
$29.95/month
Your Investment
(PLEASE CHECK ONE)
$479.40
$579.40
$39.90/month with
$49.90/month with
Revolution
Revolution
I,
(print
full
name),
have
enrolled
my
pet
_______________________into Oak View Animal Hospital ’s (OVAH) Healthy Paws Club Plan (minimum 12-month
commitment). I understand that OVAH will charge the account listed below a non-refundable enrollment fee of $39.95 and
a non-refundable monthly payment of $____________ until the end of the one-year enrollment period. If the plan is paid
in full at time of contract, the enrollment fee will be waived. The Plan will automatically renew annually unless Client
notifies OVAH in writing prior to the expiration of the initial or renewal term, of its intent to cancel future Healthy Paws
Club Plan benefits.
If payment on credit card is declined, OVAH will notify me. Declined payments will result in a $25 finance
charge (per failed transaction) in addition to original payment due. (Initial here____) I understand I am responsible for
notifying OVAH of any changes to my payment information that would interfere with payment processing. If payment
for a failed transaction is not made within a 5-day period of notification, OVAH may revoke my membership and rescind
all discounts given. Client agrees to submit full listed price for the services given up to the date of the declined payment.
(Initial here____) Membership is non-transferable to other clients or pets. (Initial here____) The OVAH Healthy
Paws Club Plan is not pet insurance. (Initial here____) Refunds will not be given on unused services. (Initial here____)
If I cancel this contract, the remainder of the balance must be paid in full. Payment will be due in full for any other
services not included in this plan.
I understand and agree to all aspects of this membership.
___________________________________________ (Signature)

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