New Client Form

* Indicates required field

Name *

First

Last

Additional name on account: *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Alternate Phone Number *

Email *

PET'S INFORMATION

Pet's Name: *

Breed: *

Color/Markings/Description *

Sex: *

Spayed or Neutered? *

Age: *

Birthdate: *

Choose Any *

I hereby grant FAMC permission to take photos and/or video of my pet and/or myself, and to publish those images,with or without my name and/or my pet’s name, for any lawful purpose, including but not limited to, their website, social media accounts, and promotional materials, either digital or in print, in perpetuity. I waive any rights of compensation associated with the use of my/my pet’s image(s) and name(s) for the purposes outlined above.

Financial Policy

Fidalgo Animal Medical Center requires payment in full at the end of your pet’s examination and/or at the time of discharge.

Payment Options:
You can choose from: Cash, Check, Visa, MasterCard, Discover card, and Care Credit.
                                Fidalgo Animal Medical Center charges $40.00 for returned checks.

Deposit & Billing:
For some treatments or hospitalized care, a deposit may be required. Healthcare plans requiring comprehensive care or more, will require a deposit to begin your pet’s treatment. We charge a minimum of $5.00 interest on all outstanding account balances older than 30 days. If you have an account balance 120 days past due, Fidalgo Animal Medical Center may relinquish your balance owed to a collection agency.

Additional Policy Information:
For clients with pet insurance, we are happy to provide you with the necessary documentation to submit a claim to your insurance carrier.

Cancellation Policy:
We ask that our clients give us 24 hour notice if they will be unable to keep their appointment. We understand that there are times when 24 hour notice is not possible. Advanced notice allows other patients to be seen during the allotted time that has been set aside for your pet.

If a client misses a second appointment without advanced notice, a fee of $25.00 may be charged to your account.
A third no show in a 24 month period can be cause for dismissal of your pet family from the practice.
Failure to keep an initial appointment to establish care may also be cause for dismissal from the practice.

New Client Appointment:
·         We require a deposit equal to the exam fee to hold the appointment, per pet.
·         This deposit is fully refundable if the appointment is cancelled with a minimum of 24 hours notice.
·         if the appointment is rescheduled with a minimum of 24 hours notice, the deposit will be transferred to the new appointment time.

If you have any questions, please do not hesitate to ask. We are here to provide the best veterinary care available for your pet.
Please help us by filling out the following information:

Driver's License Number and State *

Employer *

Alternative Contact's Name *

Alternative Contact's Phone Number *

I affirm that I am the owner or agent of the animal names above and I am over 18 years of age. My electronic name entry herein constitutes my legal signature and I agree to the foregoing terms of payment * *

First

Last

Submit

New Client Form

PET'S INFORMATION

Financial Policy

FIDALGO ANIMAL MEDICAL CENTER

office hours

In Case of Emergency

3303 Commercial Ave
Anacortes, WA 98221
FAMC@FIDALGOVETS.COM

Our Partners in care

New Client Form

PET'S INFORMATION

Financial Policy

FIDALGO ANIMAL MEDICAL CENTER

office hours

In Case of Emergency

3303 Commercial AveAnacortes, WA 98221FAMC@FIDALGOVETS.COM​​

Our Partners in care

3303 Commercial Ave
Anacortes, WA 98221
FAMC@FIDALGOVETS.COM